Provider Demographics
NPI:1114010311
Name:KWIATKOWSKI, DAVID JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JOSEPH
Last Name:KWIATKOWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE BLACKFAN CIRCLE
Mailing Address - Street 2:RM 6 216
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115
Mailing Address - Country:US
Mailing Address - Phone:617-355-9005
Mailing Address - Fax:617-355-9016
Practice Address - Street 1:44 BINNEY STREET
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-632-5320
Practice Address - Fax:617-355-9016
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA54854MASS207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3003396Medicaid
65549OtherFALLON COMMUNITY HEALTH P
A56902DFOtherHPHC DFCI ONLY
731533OtherTUFTS
MAJ03059OtherBLUE CROSS BLUE SHIELD OF
2065256OtherAETNA US HEALTHCARE
3004378OtherUNITED HEALTH CARE
9401470OtherCIGNA
65549OtherFALLON COMMUNITY HEALTH P
J03059Medicare ID - Type Unspecified