Provider Demographics
NPI:1154312791
Name:HARTUNIAN, MARGOT GRACE
Entity Type:Individual
Prefix:DR
First Name:MARGOT
Middle Name:GRACE
Last Name:HARTUNIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MOUNT AUBURN ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-5600
Mailing Address - Country:US
Mailing Address - Phone:617-492-1625
Mailing Address - Fax:617-354-5772
Practice Address - Street 1:300 MOUNT AUBURN ST
Practice Address - Street 2:SUITE 302
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5600
Practice Address - Country:US
Practice Address - Phone:617-492-1625
Practice Address - Fax:617-354-5772
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA217545207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAH92287Medicare UPIN
MAA35909Medicare ID - Type Unspecified