Provider Demographics
NPI:1295719748
Name:YANOVSKY, TANYA (MD)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:YANOVSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 FELLSMERE RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-1339
Mailing Address - Country:US
Mailing Address - Phone:781-893-8762
Mailing Address - Fax:781-899-6386
Practice Address - Street 1:20 HOPE AVE
Practice Address - Street 2:SUITE G05
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-2721
Practice Address - Country:US
Practice Address - Phone:781-893-8762
Practice Address - Fax:781-899-6386
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA502682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3012565Medicaid
MAA57083Medicare UPIN