Provider Demographics
NPI:1366484248
Name:HAAS-KOGAN, DAPHNE A (MD)
Entity Type:Individual
Prefix:DR
First Name:DAPHNE
Middle Name:A
Last Name:HAAS-KOGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DAPHNE
Other - Middle Name:A
Other - Last Name:HAAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:375 BOYLSTON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-6007
Mailing Address - Country:US
Mailing Address - Phone:857-307-0867
Mailing Address - Fax:
Practice Address - Street 1:75 FRANCIS ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6110
Practice Address - Country:US
Practice Address - Phone:617-732-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG763242085R0001X
MA2626302085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G763240Medicaid
CA00G763240Medicare PIN
CA00G763240Medicaid