Provider Demographics
NPI:1801890835
Name:YOGMAN, MICHAEL WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WILLIAM
Last Name:YOGMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 MOUNT AUBURN ST
Mailing Address - Street 2:STE 202
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-4627
Mailing Address - Country:US
Mailing Address - Phone:617-864-7071
Mailing Address - Fax:617-661-4682
Practice Address - Street 1:575 MOUNT AUBURN ST
Practice Address - Street 2:STE 202
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-4627
Practice Address - Country:US
Practice Address - Phone:617-864-7071
Practice Address - Fax:617-661-4682
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA37094208000000X, 2080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2059029Medicaid
MA2059029Medicaid
D88905Medicare UPIN