Provider Demographics
NPI:1952382301
Name:AGUS, MICHAEL SD (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SD
Last Name:AGUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LONGWOOD AVE
Mailing Address - Street 2:MAIN 11 SOUTH
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5724
Mailing Address - Country:US
Mailing Address - Phone:617-355-5849
Mailing Address - Fax:888-883-9238
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:MAIN 11 SOUTH
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-5849
Practice Address - Fax:888-883-9238
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA157152208000000X, 2080P0203X, 2080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ19867OtherBCBS MA
MA3197239Medicaid
MA157152OtherTUFTS HEALTH PLAN
MAJ19867OtherBCBS MA
MAA29421Medicare ID - Type Unspecified