Provider Demographics
NPI:1164103065
Name:MAIN, DONALD
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:MAIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:197 QUINCY AVE
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-2341
Mailing Address - Country:US
Mailing Address - Phone:781-308-3167
Mailing Address - Fax:
Practice Address - Street 1:197 QUINCY AVE
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-2341
Practice Address - Country:US
Practice Address - Phone:781-308-3167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator