Healthcare Provider Details

I. General information

NPI: 1174599930
Provider Name (Legal Business Name): ALAN DAVID DANDREA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 BINNEY ST DANA FARBER CANCER INSTITUTE
BOSTON MA
02115-6084
US

IV. Provider business mailing address

24 CALUMET RD
WINCHESTER MA
01890-3535
US

V. Phone/Fax

Practice location:
  • Phone: 617-632-2112
  • Fax: 617-632-5757
Mailing address:
  • Phone: 781-729-0898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number56413
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: