Provider Demographics
NPI:1801822564
Name:MISHKIN, DANIEL S (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:S
Last Name:MISHKIN
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 1:90 LIBBEY INDUSTRIAL PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02189-3130
Mailing Address - Country:US
Mailing Address - Phone:617-421-1091
Mailing Address - Fax:781-682-0611
Practice Address - Street 1:90 LIBBEY INDUSTRIAL PKWY STE 101
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02189-3130
Practice Address - Country:US
Practice Address - Phone:617-421-1091
Practice Address - Fax:781-682-0611
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA220601207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2075041Medicaid
MAA37429Medicare PIN
MA2075041Medicaid