Provider Demographics
NPI:1487715181
Name:AUGOT, JR., BERNARD J (LIC AC)
Entity type:Individual
Prefix:
First Name:BERNARD
Middle Name:J
Last Name:AUGOT, JR.
Suffix:
Gender:M
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ACUPUNCTURE HEALTH CARE CTR.
Mailing Address - Street 2:370 MAIN STREET
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180
Mailing Address - Country:US
Mailing Address - Phone:781-438-2626
Mailing Address - Fax:
Practice Address - Street 1:ACUPUNCTURE HEALTH CARE CTR.
Practice Address - Street 2:370 MAIN STREET
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180
Practice Address - Country:US
Practice Address - Phone:781-438-2626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA490171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist