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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
1208000000XPediatrics Physician157152MA
22080P0203XPediatric Critical Care Medicine Physician157152MA
32080P0205XPediatric Endocrinology Physician157152MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1J19867OTHERMABCBS MA
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3157152OTHERMATUFTS 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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