Provider Demographics
NPI:1306804901
Name:YORGANCIOGLU, CANDAN (MD)
Entity type:Individual
Prefix:
First Name:CANDAN
Middle Name:
Last Name:YORGANCIOGLU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CANDAN
Other - Middle Name:
Other - Last Name:ZAIMOGLU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 MAIN ST
Mailing Address - Street 2:SUITE 116
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-4540
Mailing Address - Country:US
Mailing Address - Phone:781-396-2000
Mailing Address - Fax:781-391-2619
Practice Address - Street 1:101 MAIN ST
Practice Address - Street 2:SUITE 116
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-4540
Practice Address - Country:US
Practice Address - Phone:781-396-2000
Practice Address - Fax:781-391-2619
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA226438207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0037589OtherNEIGHBORHOOD HEALTH
MA2115247Medicaid
MA494601OtherTUFTS
MAJ29856OtherBLUE CROSS
MAAA55156OtherHARVARD PILGRIM
MAA39765Medicare PIN