Healthcare Provider Details

I. General information

NPI: 1891430757
Provider Name (Legal Business Name): DYNAMICARE HEALTH MEDICAL SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2022
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 BOYLSTON ST FL 6
BOSTON MA
02116-3325
US

IV. Provider business mailing address

6 LIBERTY SQ # 2102
BOSTON MA
02109-5800
US

V. Phone/Fax

Practice location:
  • Phone: 855-539-6264
  • Fax: 617-340-2619
Mailing address:
  • Phone: 855-539-6264
  • Fax: 617-340-2619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. DAVID ROBERT GASTFRIEND
Title or Position: CHIEF MEDICAL OFFICER
Credential: MD
Phone: 855-539-6264