Healthcare Provider Details

I. General information

NPI: 1912907718
Provider Name (Legal Business Name): EDUARDO O DAGOSTINO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349 N MAIN ST
ANDOVER MA
01810-2687
US

IV. Provider business mailing address

181 WELLS AVE STE 302
NEWTON MA
02459-3344
US

V. Phone/Fax

Practice location:
  • Phone: 978-475-0959
  • Fax: 978-475-1769
Mailing address:
  • Phone: 781-972-7136
  • Fax: 781-972-7166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number44715
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: