Healthcare Provider Details

I. General information

NPI: 1194950337
Provider Name (Legal Business Name): JOHN DANIEL GIANNONE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2009
Last Update Date: 07/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 NEWTON ST
SOUTHBOROUGH MA
01772-1215
US

IV. Provider business mailing address

630 PLANTATION ST
WORCESTER MA
01605-2038
US

V. Phone/Fax

Practice location:
  • Phone: 508-460-3190
  • Fax: 508-460-3279
Mailing address:
  • Phone: 508-368-5532
  • Fax: 508-460-3279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number261076
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: