Provider Demographics
NPI:1457326803
Name:YAVSHAYAN, AIDA M (MD)
Entity Type:Individual
Prefix:DR
First Name:AIDA
Middle Name:M
Last Name:YAVSHAYAN
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 1:375 MOUNT AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-1930
Mailing Address - Country:US
Mailing Address - Phone:617-926-2220
Mailing Address - Fax:617-926-2230
Practice Address - Street 1:375 MOUNT AUBURN ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472
Practice Address - Country:US
Practice Address - Phone:617-926-2220
Practice Address - Fax:617-926-2230
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA150875208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2836068OtherAETNA
MA3164080Medicaid
MA7969326002OtherCIGNA
MA26989OtherCHILDREN'S MEDICAL SECURITY
MAJ17424OtherBLUE CROSS BLUE SHIELD
MA1457326803OtherNEIGHBORHOOD HEALTH PLAN
MA1200057OtherUNITED HEALTH
MA150875OtherTUFTS
MA201562OtherHARVARD PILGRIM HLTH PLAN
MAA22324Medicare ID - Type Unspecified
MA7969326002OtherCIGNA