Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 14591 | MA |
Y | 213EG0000X | General Practice | 14591 | MA |
NPI | 1003948936 |
---|---|
Provider Name | Dr. Peter Dana |
First Address | Watertown, MA 02472-3928 |
Second Address | Watertown, MA 02472-3928 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2007 |
Last Update Date | 08/07/2007 |