MEDICARE: DANIEL C BROCKS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	270838	MA
2	207W00000X	Ophthalmology Physician	239164-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174797468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL C BROCKS MD

Provider Business Mailing Address
First Line	:	464 HILLSIDE AVE
Second Line	:	STE 205
City	:	NEEDHAM
State	:	MA
Zip	:	02494-1228
Country	:	US
Telephone Number	:	781-726-7337
Fax Number	:	781-726-7311

Provider Business Practice Location Address
First Line	:	464 HILLSIDE AVE STE 205
Second Line	:
City	:	NEEDHAM
State	:	MA
Zip	:	02494-1228
Country	:	US
Telephone Number	:	781-726-7505
Fax Number	:	845-896-0246

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2008
Last Update Date	:	12/27/2021

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