Provider Demographics
NPI:1346200698
Name:SIMON, DAVID K (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:K
Last Name:SIMON
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:BETH ISRAEL DEACONESS MED. CTR.
Mailing Address - Street 2:330 BROOKLINE AVENUE; ROOM CLS-638
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215
Mailing Address - Country:US
Mailing Address - Phone:617-735-3251
Mailing Address - Fax:617-735-2826
Practice Address - Street 1:BETH ISRAEL DEACONESS MED. CTR.
Practice Address - Street 2:330 BROOKLINE AVENUE; ROOM CLS-638
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215
Practice Address - Country:US
Practice Address - Phone:617-735-3251
Practice Address - Fax:617-735-2826
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA819662084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAG26271Medicare UPIN