Healthcare Provider Details

I. General information

NPI: 1700843166
Provider Name (Legal Business Name): DANIEL JAY PALLIN MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 02/24/2020
Certification Date: 02/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST BRIGHAM & WOMEN'S HOSPITAL DEPARTMENT OF EMERGENCY MEDI
BOSTON MA
02115
US

IV. Provider business mailing address

75 FRANCIS ST BRIGHAM & WOMEN'S HOSPITAL DEPARTMENT OF EMERGENCY MEDI
BOSTON MA
02115
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-5640
  • Fax:
Mailing address:
  • Phone: 617-732-5640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number64730
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number214353
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: