Provider Demographics
NPI:1801389655
Name:YAMAGUCHI, TAKAHIRO (MD)
Entity Type:Individual
Prefix:
First Name:TAKAHIRO
Middle Name:
Last Name:YAMAGUCHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 ALFRED ST
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-1976
Mailing Address - Country:US
Mailing Address - Phone:781-933-6236
Mailing Address - Fax:
Practice Address - Street 1:7 ALFRED ST
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-1976
Practice Address - Country:US
Practice Address - Phone:781-933-6236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-07
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP04355208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics