Provider Demographics
NPI:1821194879
Name:GAPOSCHKIN, DANIEL P (MD/PHD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:P
Last Name:GAPOSCHKIN
Suffix:
Gender:M
Credentials:MD/PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 MANNION PL
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:MA
Mailing Address - Zip Code:01460-2229
Mailing Address - Country:US
Mailing Address - Phone:978-952-6545
Mailing Address - Fax:
Practice Address - Street 1:40 SECOND AVE
Practice Address - Street 2:SUITE #400
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02154
Practice Address - Country:US
Practice Address - Phone:781-487-4350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA222235207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2081245Medicaid
I15430Medicare UPIN
MA2081245Medicaid