Provider Demographics
NPI:1679763718
Name:DAVID, DAVE E (MD)
Entity Type:Individual
Prefix:
First Name:DAVE
Middle Name:E
Last Name:DAVID
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1208B VFW PKWY STE 305
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-4350
Mailing Address - Country:US
Mailing Address - Phone:508-505-6474
Mailing Address - Fax:603-215-4960
Practice Address - Street 1:1208B VFW PKWY STE 305
Practice Address - Street 2:
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-4350
Practice Address - Country:US
Practice Address - Phone:508-505-6474
Practice Address - Fax:603-215-4960
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA44906208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery