Provider Demographics
NPI:1326038043
Name:AYATA, CENK (MD)
Entity Type:Individual
Prefix:DR
First Name:CENK
Middle Name:
Last Name:AYATA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-4484
Mailing Address - Fax:617-726-2547
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:BLK 12
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-0821
Practice Address - Fax:617-726-2547
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2094292084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA209729OtherTUFTS HEALTH PLAN
MA0155080Medicaid
MAJ24278OtherBCBS MA
H68687Medicare UPIN
MA209729OtherTUFTS HEALTH PLAN