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1952382301

NPI Code Detail

MEDICARE: DR. MICHAEL SD AGUS MD

MEDICARE: DR. MICHAEL SD AGUS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	157152	MA
2	2080P0203X	Pediatric Critical Care Medicine Physician	157152	MA
3	2080P0205X	Pediatric Endocrinology Physician	157152	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	J19867	OTHER	MA	BCBS MA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	157152	OTHER	MA	TUFTS HEALTH PLAN

General Provider Information

NPI Number	:	1952382301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL SD AGUS MD

Provider Business Mailing Address
First Line	:	300 LONGWOOD AVE
Second Line	:	MAIN 11 SOUTH
City	:	BOSTON
State	:	MA
Zip	:	02115-5724
Country	:	US
Telephone Number	:	617-355-5849
Fax Number	:	888-883-9238

Provider Business Practice Location Address
First Line	:	300 LONGWOOD AVE
Second Line	:	MAIN 11 SOUTH
City	:	BOSTON
State	:	MA
Zip	:	02115-5724
Country	:	US
Telephone Number	:	617-355-5849
Fax Number	:	888-883-9238

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	04/10/2014

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Directions to “ DR. MICHAEL SD AGUS MD” Practice Location

Language	Start Address	Practice Location

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