Provider Demographics
NPI:1568554475
Name:BYRON V HARTUNIAN MD PC
Entity Type:Organization
Organization Name:BYRON V HARTUNIAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:V
Authorized Official - Last Name:HARTUNIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-864-5700
Mailing Address - Street 1:777 CONCORD AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1056
Mailing Address - Country:US
Mailing Address - Phone:617-864-5700
Mailing Address - Fax:617-864-0883
Practice Address - Street 1:777 CONCORD AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1056
Practice Address - Country:US
Practice Address - Phone:617-864-5700
Practice Address - Fax:617-864-0883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA40158174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM13717OtherBLUE SHIELD
MA9727302Medicaid
MA040158OtherTUFTS
MAM13717OtherBLUE SHIELD
MAM13717Medicare ID - Type Unspecified