=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629384995
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AARON KOENIG M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2010
-----------------------------------------------------
Last Update Date | 06/08/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 178 OAKLAND ST
-----------------------------------------------------
City | WELLESLEY
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02481-5323
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-356-4114
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 178 OAKLAND ST # 149-2691
-----------------------------------------------------
City | WELLESLEY
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02481-5323
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-356-4114
-----------------------------------------------------
Fax | 617-726-5760
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0805X
-----------------------------------------------------
Taxonomy Name | Geriatric Psychiatry Physician
-----------------------------------------------------
License Number | 263578
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------