Provider Demographics
NPI:1205818721
Name:YANG, JUDY Z (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:Z
Last Name:YANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:FANGFANG
Other - Middle Name:
Other - Last Name:ZHANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2014 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02462-1607
Mailing Address - Country:US
Mailing Address - Phone:617-243-5155
Mailing Address - Fax:617-243-5090
Practice Address - Street 1:2014 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462-1607
Practice Address - Country:US
Practice Address - Phone:617-243-5155
Practice Address - Fax:617-243-5090
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216675207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2012197Medicaid
MAYA A35216Medicare ID - Type Unspecified
MA2012197Medicaid