Provider Demographics
NPI:1528073202
Name:MIDDLESEX FAMILY PRACTICE PC
Entity type:Organization
Organization Name:MIDDLESEX FAMILY PRACTICE PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMIL
Authorized Official - Middle Name:
Authorized Official - Last Name:YAGUDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-270-8844
Mailing Address - Street 1:74 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-2952
Mailing Address - Country:US
Mailing Address - Phone:508-270-8844
Mailing Address - Fax:
Practice Address - Street 1:74 MAIN ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-2952
Practice Address - Country:US
Practice Address - Phone:508-270-8844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA80763207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3140911Medicaid
MAYAA20582Medicare ID - Type UnspecifiedMEDICARE
MA3140911Medicaid