Provider Demographics
NPI:1154312791
Name:HARTUNIAN, MARGOT GRACE
Entity type:Individual
Prefix:DR
First Name:MARGOT
Middle Name:GRACE
Last Name:HARTUNIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 HARTWELL AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-3132
Mailing Address - Country:US
Mailing Address - Phone:781-862-3800
Mailing Address - Fax:781-862-3855
Practice Address - Street 1:24 HARTWELL AVE STE 204
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-3132
Practice Address - Country:US
Practice Address - Phone:781-862-3800
Practice Address - Fax:781-862-3855
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA217545207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAH92287Medicare UPIN
MAA35909Medicare ID - Type Unspecified