Provider Demographics
NPI:1346270337
Name:FRAM, DANIEL KENNETH (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:KENNETH
Last Name:FRAM
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 1:291 MOODY ST
Mailing Address - Street 2:
Mailing Address - City:LUDLOW
Mailing Address - State:MA
Mailing Address - Zip Code:01056-1246
Mailing Address - Country:US
Mailing Address - Phone:800-866-6663
Mailing Address - Fax:413-589-0195
Practice Address - Street 1:111 COLCHESTER AVE
Practice Address - Street 2:RADIATION ONCOLOGY, FAHC
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1473
Practice Address - Country:US
Practice Address - Phone:802-847-3506
Practice Address - Fax:802-847-2386
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-00115772085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6618405Medicaid
PA0015052230006Medicaid
NJ782282A8QMedicare ID - Type Unspecified
NJ6618405Medicaid
F55350Medicare UPIN