Provider Demographics
NPI:1154311777
Name:YEH, BERHAN S (MD)
Entity Type:Individual
Prefix:DR
First Name:BERHAN
Middle Name:S
Last Name:YEH
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 1:286 PICNIC ST
Mailing Address - Street 2:
Mailing Address - City:BOXBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01719
Mailing Address - Country:US
Mailing Address - Phone:978-466-2994
Mailing Address - Fax:978-466-2993
Practice Address - Street 1:320 1ST ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20534-0002
Practice Address - Country:US
Practice Address - Phone:508-816-4620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA208788207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0136531Medicaid
MAA3241702Medicare PIN
MAA3241701Medicare PIN
A32417Medicare ID - Type Unspecified
MA0136531Medicaid