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General NPI Number Information
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NPI Number | 1083246870
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Entity Type | Individual
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Provider Name | DANIEL THOMAS SPICER PHYSICIAN ASSISTANT
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Gender | Male
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Dates
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Enumeration Date | 02/10/2020
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Last Update Date | 11/06/2024
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Provider Practice Location Address
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Address Line | 136 HARRISON AVE
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City | BOSTON
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State | MA
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Zip | 02111-1817
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Country | US
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Telephone | 508-887-3378
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Fax |
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Provider Business Mailing Address
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Address Line | 11 ELMWOOD ST
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City | SOMERVILLE
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State | MA
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Zip | 02144-2407
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA7420
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License Number State | MA
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