Healthcare Provider Details

I. General information

NPI: 1083726111
Provider Name (Legal Business Name): DANIEL M EPSTEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 MT AUBURN ST EPSTEIN BALLENGER T GOLDSTEIN
CAMBRIDGE MA
02138-6844
US

IV. Provider business mailing address

91 CHILDTON ST
CAMBRIDGE MA
02138
US

V. Phone/Fax

Practice location:
  • Phone: 617-354-6660
  • Fax:
Mailing address:
  • Phone: 617-547-5875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number49447
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: