Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 78218 | MA |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 78218 | MA |
N | 2081P2900X | Pain Medicine | 78218 | MA |
N | 2081S0010X | Sports Medicine | 78218 | MA |
N | 213ES0000X | Sports Medicine | 78218 | MA |
NPI | 1104811900 |
---|---|
Provider Name | David Marc Blaustein |
First Address | West Roxbury, MA 02132 |
Second Address | West Roxbury, MA 02132 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2005 |
Last Update Date | 26/04/2019 |