Provider Demographics
NPI:1073855755
Name:ROH, DANIEL S (MD)
Entity Type:Individual
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First Name:DANIEL
Middle Name:S
Last Name:ROH
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Gender:M
Credentials:MD
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Mailing Address - Street 1:960 MASSACHUSETTS AVENUE
Mailing Address - Street 2:FL 2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2690
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:725 ALBANY STREET, STE 3A
Practice Address - Street 2:SHAPIRO BLDG.
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118
Practice Address - Country:US
Practice Address - Phone:617-638-8419
Practice Address - Fax:617-414-0201
Is Sole Proprietor?:No
Enumeration Date:2013-03-20
Last Update Date:2024-04-05
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Provider Licenses
StateLicense IDTaxonomies
MA281141208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110112423AMedicaid
MA3125085Medicaid