Provider Demographics
NPI:1164610614
Name:DASTGEER, GHULAM M (MD, FRCS, ABUCM)
Entity Type:Individual
Prefix:DR
First Name:GHULAM
Middle Name:M
Last Name:DASTGEER
Suffix:
Gender:M
Credentials:MD, FRCS, ABUCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4674 JASPER LN
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-8131
Mailing Address - Country:US
Mailing Address - Phone:303-465-1905
Mailing Address - Fax:303-410-6903
Practice Address - Street 1:421 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LEEDS
Practice Address - State:MA
Practice Address - Zip Code:01053-9764
Practice Address - Country:US
Practice Address - Phone:413-584-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA48962208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice