Provider Demographics
NPI:1497735500
Name:VIN, YAEL (MD)
Entity Type:Individual
Prefix:
First Name:YAEL
Middle Name:
Last Name:VIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 NORTH BEACON STREET
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135
Mailing Address - Country:US
Mailing Address - Phone:617-783-5200
Mailing Address - Fax:617-783-5202
Practice Address - Street 1:116 NORTH BEACON STREET
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135
Practice Address - Country:US
Practice Address - Phone:617-783-5200
Practice Address - Fax:617-783-5202
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2368812085R0202X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA212277OtherMEDICAL LICENSE
MA2167484Medicaid
MA000691401OtherMEDICARE PTAN
G44150Medicare UPIN
775T81Medicare ID - Type Unspecified