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General NPI Number Information
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NPI Number | 1841280047
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Entity Type | Individual
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Provider Name | DONALD JOHN DERASKA MD
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Gender | Male
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Dates
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Enumeration Date | 10/27/2005
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Last Update Date | 10/30/2018
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Provider Practice Location Address
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Address Line | 92 MONTVALE AVE STE 3675
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City | STONEHAM
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State | MA
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Zip | 02180-3625
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Country | US
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Telephone | 781-438-1800
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Fax | 781-438-1822
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Provider Business Mailing Address
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Address Line | 92 MONTVALE AVE STE 3675
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City | STONEHAM
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State | MA
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Zip | 02180-3625
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Country | US
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Telephone | 781-438-1800
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Fax | 781-438-1822
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 73990
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 73990
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License Number State | MA
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