Provider Demographics
NPI:1699837963
Name:WASHBURN, DANA STANLEY (MD)
Entity Type:Individual
Prefix:
First Name:DANA STANLEY
Middle Name:
Last Name:WASHBURN
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 1:19 BROOKDALE AVE
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-1003
Mailing Address - Country:US
Mailing Address - Phone:781-235-3919
Mailing Address - Fax:
Practice Address - Street 1:19 BROOKDALE AVE
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-1003
Practice Address - Country:US
Practice Address - Phone:781-235-3919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA72321207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease