Healthcare Provider Details

I. General information

NPI: 1932526241
Provider Name (Legal Business Name): DANIEL DAMONN HEGG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2014
Last Update Date: 05/12/2021
Certification Date: 04/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1493 CAMBRIDGE STREET CHA DEPARTMENT OF EMERGENCY MEDICINE
CAMBRIDGE MA
02139-1047
US

IV. Provider business mailing address

1493 CAMBRIDGE ST
CAMBRIDGE MA
02139-1047
US

V. Phone/Fax

Practice location:
  • Phone: 617-665-1430
  • Fax:
Mailing address:
  • Phone: 617-732-8070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number273631
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: