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General NPI Number Information
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NPI Number | 1104811900
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Entity Type | Individual
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Provider Name | DAVID MARC BLAUSTEIN MD
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Gender | Male
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Dates
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Enumeration Date | 09/18/2005
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Last Update Date | 04/26/2019
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Provider Practice Location Address
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Address Line | 1400 VFW PARKWAY VA BOSTON HEALTHCARE SYSTEM
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City | WEST ROXBURY
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State | MA
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Zip | 02132
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Country | US
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Telephone | 857-203-6931
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Fax | 857-203-5680
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Provider Business Mailing Address
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Address Line | 1400 VFW PARKWAY VA BOSTON HEALTHCARE SYSTEM
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City | WEST ROXBURY
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State | MA
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Zip | 02132
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Country | US
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Telephone | 857-203-6931
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Fax | 857-203-5680
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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 | 204C00000X
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Taxonomy Name | Sports Medicine (Neuromusculoskeletal Medicine) Physician
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License Number | 78218
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 78218
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 2081N0008X
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Taxonomy Name | Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 78218
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 78218
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License Number State | MA
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Taxonomy #5
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 78218
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License Number State | MA
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