Provider Demographics
NPI:1316108079
Name:CANAN AVUNDUK, MD. PHD
Entity type:Organization
Organization Name:CANAN AVUNDUK, MD. PHD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ACCOUNT REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:CATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-979-6366
Mailing Address - Street 1:1715 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SAUGUS
Mailing Address - State:MA
Mailing Address - Zip Code:01906-4703
Mailing Address - Country:US
Mailing Address - Phone:781-979-6370
Mailing Address - Fax:781-979-6373
Practice Address - Street 1:536 LEBANON ST
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-3523
Practice Address - Country:US
Practice Address - Phone:781-979-0286
Practice Address - Fax:781-979-0324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA46084207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
M17346OtherBLUE SHIELD PROVIDER NUMBER
MA6175864Medicaid
683460OtherTUFTS PROVIDER NUMBER
M17346OtherBLUE SHIELD PROVIDER NUMBER