Provider Demographics
NPI:1568421279
Name:DATU, JOYCELYN A (MD)
Entity Type:Individual
Prefix:DR
First Name:JOYCELYN
Middle Name:A
Last Name:DATU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 CONCORD AVE
Mailing Address - Street 2:BELMONT MEDICAL ASSOCIATES
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1040
Mailing Address - Country:US
Mailing Address - Phone:617-864-8822
Mailing Address - Fax:617-864-0099
Practice Address - Street 1:725 CONCORD AVE
Practice Address - Street 2:BELMONT MEDICAL ASSOCIATES
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1040
Practice Address - Country:US
Practice Address - Phone:617-864-8822
Practice Address - Fax:617-864-0099
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA81128207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA042596628OtherPHCS
MAAA17883OtherHARVARD PILGRIM
MAM12605OtherBCBS
MA042596628OtherHCVM
MA715734OtherTUFTS
MA3149455Medicaid
MA042596628OtherHCVM
MA042596628OtherPHCS
MAM12605OtherBCBS