Provider Demographics
NPI:1376614412
Name:HURTADO, DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:HURTADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:85 E INDIA ROW
Mailing Address - Street 2:UNIT 35-G
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02110-3320
Mailing Address - Country:US
Mailing Address - Phone:857-891-8788
Mailing Address - Fax:617-427-6220
Practice Address - Street 1:2181 WASHINGTON ST
Practice Address - Street 2:SUITE 305
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02119-2082
Practice Address - Country:US
Practice Address - Phone:617-541-0772
Practice Address - Fax:617-427-6220
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA215879208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3110263OtherAETNA
MA43531603OtherHCVM
MAJ25762OtherBLUE CROSS BLUE SHIELD
MA2005531OtherMASS HEALTH
MA2300293OtherUNITIED HEALTHCARE
MA3110263OtherAETNA
MA2300293OtherUNITIED HEALTHCARE