Provider Demographics
NPI:1770681538
Name:GOSSELIN, DANIEL R (PA)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:R
Last Name:GOSSELIN
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:41 MALL RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01805-0001
Mailing Address - Country:US
Mailing Address - Phone:781-744-7000
Mailing Address - Fax:781-744-5352
Practice Address - Street 1:67 S BEDFORD ST STE 202E
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-5141
Practice Address - Country:US
Practice Address - Phone:781-744-7000
Practice Address - Fax:781-744-5352
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA598363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA970022267OtherRAILROAD MEDICARE
MAAP0358Medicare PIN