Provider Demographics
NPI:1942313531
Name:BEHLAU, IRMGARD (MD)
Entity Type:Individual
Prefix:DR
First Name:IRMGARD
Middle Name:
Last Name:BEHLAU
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1380 SOLDIERS FIELD ROAD 2ND FLOOR MAGGIE CUSTODIO
Mailing Address - Street 2:MOUNT AUBURN CAMBRIDGE INDEPENDENT PRACTICE ASSOCIATION
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135
Mailing Address - Country:US
Mailing Address - Phone:617-499-5026
Mailing Address - Fax:617-499-5453
Practice Address - Street 1:1380 SOLDIERS FIELD ROAD, 2ND FLOOR MAGGIE CUSTODIO
Practice Address - Street 2:MOUNT AUBURN CAMBRIDGE INDEPENDENT PRACTICE ASSOCIATION
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135
Practice Address - Country:US
Practice Address - Phone:617-783-7200
Practice Address - Fax:617-787-1760
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA75971207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ19423OtherBCBS MA
MA792606OtherTUFTS HEALTH PLAN
MA3185834Medicaid
MAA28865Medicare ID - Type Unspecified
MA3185834Medicaid