Provider Demographics
NPI:1306813332
Name:WASSERMAN, JONATHAN DANIEL (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:DANIEL
Last Name:WASSERMAN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 UNIVERSITY AVENUE
Mailing Address - Street 2:
Mailing Address - City:TORONTO
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:M5G 1X8
Mailing Address - Country:CA
Mailing Address - Phone:416-813-7654
Mailing Address - Fax:416-813-6304
Practice Address - Street 1:555 UNIVERSITY AVENUE
Practice Address - Street 2:
Practice Address - City:TORONTO
Practice Address - State:ONTARIO
Practice Address - Zip Code:M5G 1X8
Practice Address - Country:CA
Practice Address - Phone:416-813-7654
Practice Address - Fax:416-813-6304
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA217797208000000X
ZZ884682080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics