Provider Demographics
NPI:1619925898
Name:GURYANOVA, IRINA A (MD)
Entity Type:Individual
Prefix:DR
First Name:IRINA
Middle Name:A
Last Name:GURYANOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:IRINE
Other - Middle Name:
Other - Last Name:GURYANOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10 MOHEGAN RD
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-2535
Mailing Address - Country:US
Mailing Address - Phone:978-302-0207
Mailing Address - Fax:
Practice Address - Street 1:9 HOPE AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-2741
Practice Address - Country:US
Practice Address - Phone:781-647-6786
Practice Address - Fax:781-647-6753
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 971702084P0800X
MA2029462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA202946OtherMA LICENSE #