Provider Demographics
NPI:1851383756
Name:SAGOV, STANLEY E (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:E
Last Name:SAGOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:11 WATER ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-4812
Mailing Address - Country:US
Mailing Address - Phone:781-648-9700
Mailing Address - Fax:781-648-0234
Practice Address - Street 1:11 WATER ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-4812
Practice Address - Country:US
Practice Address - Phone:781-648-9700
Practice Address - Fax:781-648-0234
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA32932207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2016583Medicaid
A37999Medicare UPIN
MA2016583Medicaid