Healthcare Provider Details

I. General information

NPI: 1508876871
Provider Name (Legal Business Name): DANIEL DAVID KOELLIKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2014 WASHINGTON ST PATHOLOGY DEPARTMENT, NEWTON-WELLESLEY HOSPITAL
NEWTON MA
02462-1607
US

IV. Provider business mailing address

5 LIGHTHOUSE LN
BARRINGTON RI
02806-2829
US

V. Phone/Fax

Practice location:
  • Phone: 617-243-6140
  • Fax: 617-243-5809
Mailing address:
  • Phone: 401-245-2389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number79822
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number79822
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: