Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Nicodeme Wanko Agassy, MD

Individual provider General Practice Physician · NPI 1477044550

Dr. Nicodeme Wanko Agassy, MD is a Diagnostic Radiology in Boston, Massachusetts. Graduated from State University of Ny Upstate Medical University in 2018, 8 years ago. Works from 2 locations. Licensed in Massachusetts, New Jersey and Texas.

Years since qualifying
8
Trained at
State University of Ny Upstate Medical University
Licensed in
MA, NJ, TX
In the registry since
2018
Specialties on file
3
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

75 Francis St
Boston, MA 02115-6110
Phone: (617) 732-5500
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1 Robert Wood Johnson Pl, New Brunswick, NJ 08901-1928 — (240) 715-7885

Specialties & licences

Diagnostic Radiology Physician (primary) Taxonomy 2085R0202X · Licence 1026325 (MA)
General Practice Physician Taxonomy 208D00000X · Licence 25MA11170500 (NJ)
Diagnostic Radiology Physician Taxonomy 2085R0202X · Licence W5615 (TX)

Record details

NPI number1477044550
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedMay 23, 2018
Last updated in NPPESJune 4, 2026
Certification dateJune 4, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyDIAGNOSTIC RADIOLOGY
Medical schoolSTATE UNIVERSITY OF NY UPSTATE MEDICAL UNIVERSITY
Graduated 2018 (8 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

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