Provider Demographics
NPI:1629068713
Name:BIONDI, DAVID M (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:BIONDI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:125 NASHUA ST
Practice Address - Street 2:SRH
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-1101
Practice Address - Country:US
Practice Address - Phone:617-573-2106
Practice Address - Fax:617-573-2229
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2078792084N0400X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Not Answered208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0126772Medicaid
MA410461OtherTUFTS HEALTH PLAN
MAJ23180OtherBCBS MA
MAJ23180OtherBCBS MA
MA0126772Medicaid