Provider Demographics
NPI:1720015928
Name:FEFFERMAN, DAVID SAMUEL (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:SAMUEL
Last Name:FEFFERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 MONTVALE AVE
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-3623
Mailing Address - Country:US
Mailing Address - Phone:781-864-1295
Mailing Address - Fax:781-665-4162
Practice Address - Street 1:3 WOODLAND RD
Practice Address - Street 2:SUITE 306
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-1702
Practice Address - Country:US
Practice Address - Phone:781-665-3380
Practice Address - Fax:781-665-4162
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA223626207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2108828Medicaid
MA468492OtherTUFTS HEALTH PLAN
MA3841156OtherAETNA
MAJ28621OtherBLUE CROSS & BLUE SHIELD
MAAA34654OtherHARVARD PILGRIM
MA2108828Medicaid
MAA38369Medicare PIN