Healthcare Provider Details

I. General information

NPI: 1457326803
Provider Name (Legal Business Name): AIDA M. YAVSHAYAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 01/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 MOUNT AUBURN ST
WATERTOWN MA
02472
US

IV. Provider business mailing address

375 MOUNT AUBURN ST
WATERTOWN MA
02472-1930
US

V. Phone/Fax

Practice location:
  • Phone: 617-926-2220
  • Fax: 617-926-2230
Mailing address:
  • Phone: 617-926-2220
  • Fax: 617-926-2230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number150875
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: