Provider Demographics
NPI:1649217308
Name:MEENAN, DAVID M (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:MEENAN
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:133 BROOKLINE AVE
Mailing Address - Street 2:INTERNAL MEDICINE
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-3904
Mailing Address - Country:US
Mailing Address - Phone:617-421-1192
Mailing Address - Fax:617-421-1187
Practice Address - Street 1:133 BROOKLINE AVE
Practice Address - Street 2:INTERNAL MEDICINE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-3904
Practice Address - Country:US
Practice Address - Phone:617-421-1192
Practice Address - Fax:617-421-1187
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2020-10-19
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Provider Licenses
StateLicense IDTaxonomies
MA159120207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0174840Medicaid
MAMX6709Medicare PIN