Provider Demographics
NPI:1376525576
Name:BUZARD, DANIEL A (NP)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:A
Last Name:BUZARD
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 MOUNT VERNON ST
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-2825
Mailing Address - Country:US
Mailing Address - Phone:617-816-5451
Mailing Address - Fax:
Practice Address - Street 1:211 MOUNT VERNON ST
Practice Address - Street 2:
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-2825
Practice Address - Country:US
Practice Address - Phone:617-816-5451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2009-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA193025363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1200992Medicaid
MANP0148Medicare ID - Type Unspecified
S21157Medicare UPIN