Provider Demographics
NPI:1417921925
Name:HARNETT, DAVID S (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:S
Last Name:HARNETT
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 1:170 GOVERNORS AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-1643
Mailing Address - Country:US
Mailing Address - Phone:781-306-6160
Mailing Address - Fax:781-306-6175
Practice Address - Street 1:170 GOVERNORS AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-1643
Practice Address - Country:US
Practice Address - Phone:781-306-6160
Practice Address - Fax:781-306-6175
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA437652084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAC04851OtherBLUE CROSS/BLUE SHIELD
MA0194778Medicaid
MA002512686130OtherOXFORD
MA260005817OtherRAILROAD MEDICARE
MA700220OtherTUFTS/SECURE HORIZONS
MA260005817OtherRAILROAD MEDICARE
MAC04851OtherBLUE CROSS/BLUE SHIELD
MAA38298Medicare UPIN