Healthcare Provider Details

I. General information

NPI: 1508971490
Provider Name (Legal Business Name): PAUL DAVID M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 ROKEBY RD
WABAN MA
02468-2156
US

IV. Provider business mailing address

PO BOX 191
WABAN MA
02468-0002
US

V. Phone/Fax

Practice location:
  • Phone: 617-921-5098
  • Fax: 617-910-3059
Mailing address:
  • Phone: 617-921-5098
  • Fax: 617-910-3059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number40219
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: