Provider Demographics
NPI:1770625014
Name:AGOSTI, RUDOLPH A (MD)
Entity type:Individual
Prefix:MR
First Name:RUDOLPH
Middle Name:A
Last Name:AGOSTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:57 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST BOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581
Mailing Address - Country:US
Mailing Address - Phone:508-366-0406
Mailing Address - Fax:508-366-6221
Practice Address - Street 1:57 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST BOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581
Practice Address - Country:US
Practice Address - Phone:508-366-0406
Practice Address - Fax:508-366-6221
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2096782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
I23009Medicare UPIN