MEDICARE: DR. WILLARD MANNING DAGGETT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	25915	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	M03882	OTHER	MA	BCBS MA
3	25915	OTHER	MA	TUFTS HEALTH PLAN

General Provider Information

NPI Number	:	1881683936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLARD MANNING DAGGETT MD

Provider Business Mailing Address
First Line	:	PO BOX 9142
Second Line	:	MASS GENERAL PHYSICIAN ORGANIZATION
City	:	CHARLESTOWN
State	:	MA
Zip	:	02129-9142
Country	:	US
Telephone Number	:	617-724-0287
Fax Number	:	617-726-2894

Provider Business Practice Location Address
First Line	:	7 CENTRE ST
Second Line	:
City	:	DOVER
State	:	MA
Zip	:	02030-2203
Country	:	US
Telephone Number	:	617-726-8840
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	07/08/2007

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