Provider Demographics
NPI:1861460016
Name:BABAYAN, EMMA (MD)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:BABAYAN
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 1:7 HERITAGE LANE
Mailing Address - Street 2:
Mailing Address - City:SAUGUS
Mailing Address - State:MA
Mailing Address - Zip Code:01906
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:365 MAIN ST
Practice Address - Street 2:PC SHAH MD INC
Practice Address - City:WINTHROP
Practice Address - State:MA
Practice Address - Zip Code:02152
Practice Address - Country:US
Practice Address - Phone:617-846-5352
Practice Address - Fax:617-846-1062
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA159467207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3204634Medicaid
H09856Medicare UPIN
MA3204634Medicaid