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Provider Information for 1770592511

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DR. DANIEL S KAMIN MD

Gender: MALE

Individual NPI: 1770592511

Calendar   Last Updated:  2007-07-08
  Certification Date: 

Details

Name Value
NPI 1770592511
Enumeration Date 2006-08-07
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 24C LAKE ST
SOMERVILLE, MA 02143-2913
United States

Phone: 617-764-2124 | Fax:
View Map External Link
Primary Practice Address 300 LONGWOOD AVE
BOSTON, MA 02115-5724
United States

Phone: 617-355-6058 | Fax: 617-730-0495
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
MEDICAID MA 2103311
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 2080P0206X - Pediatrics Pediatric Gastroenterology MA 212330