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General NPI Number Information
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NPI Number | 1750592762
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Entity Type | Organization
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Legal Business Name | DANA K. FUGELSO, M.D.
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1101 BEACON ST SUITE 1 WEST
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City | BROOKLINE
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State | MA
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Zip | 02446-5587
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Country | US
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Telephone | 781-731-8334
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Fax | 781-731-8556
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Provider Business Mailing Address
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Address Line | 1101 BEACON ST SUITE 1 WEST
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City | BROOKLINE
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State | MA
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Zip | 02446-5587
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Country | US
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Telephone | 781-731-8334
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Fax | 781-731-8556
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | DR. DANA K FUGELSO
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Credential | M.D.
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Telephone | 781-731-8334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 74545
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License Number State | MA
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