Healthcare Provider Details

I. General information

NPI: 1457413783
Provider Name (Legal Business Name): DANIEL PATRICK BREEN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 BELCHERTOWN RD
WARE MA
01082-9420
US

IV. Provider business mailing address

407 BELCHERTOWN RD
WARE MA
01082-9420
US

V. Phone/Fax

Practice location:
  • Phone: 413-552-8052
  • Fax:
Mailing address:
  • Phone: 413-552-8052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2140
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: