Individual
DR. MICHAEL SD AGUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
300 LONGWOOD AVE, MAIN 11 SOUTH, BOSTON, MA 02115-5724
(617) 355-5849
(888) 883-9238
Mailing address
300 LONGWOOD AVE, MAIN 11 SOUTH, BOSTON, MA 02115-5724
(617) 355-5849
(888) 883-9238
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
157152
MA
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
157152
MA
2080P0205X
Pediatric Endocrinology Physician
157152
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
157152
TUFTS HEALTH PLAN
MA
05
—
3197239
—
MA
01
—
J19867
BCBS MA
MA
Enumeration date
11/10/2005
Last updated
04/10/2014
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