Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN0400X | Neurology | 000803 | CT |
Y | 111NN0400X | Neurology | 1420 | MA |
N | 111NN0400X | Neurology | X005816 | NY |
NPI | 1669473997 |
---|---|
Provider Name | Dr. Daniel Joseph Fanselow |
First Address | Westboro, MA 01581-1407 |
Second Address | Westboro, MA 01581-1407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 08/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
043255443 | TAX ID (01) | MA |
14312 | FALLON (01) | MA |
210554 | AMERICAN SPECIALTY HEALTH (01) | MA |
35251 | HARVARD PILGRIM HEALTHCAR (01) | MA |
42083126 | AETNA (01) | MA |
4400279 | UNITED HEALTHCARE (01) | MA |
546258 | US HEALTH CARE (01) | MA |
59090 | FIRST HEALTH/HCVM (01) | MA |
739970 | TUFTS (01) | MA |
9903976 | (05) | MA |
FAY35984 | BLUE CROSS BLUE SHIELD (01) | MA |
U21921 | (02) | MA |
W200631 | CIGNA (01) | MA |