Individual
MIKHAIL VYDRIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
55 LAKE AVE N, DEPARTMENT OF NEUROLOGY, WORCESTER, MA 01655-0002
(508) 334-2527
(508) 334-6778
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
153858
MA
2084S0012X
Sleep Medicine (Psychiatry & Neurology) Physician
153858
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3171965
—
MA
Enumeration date
12/12/2005
Last updated
12/15/2020
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