Provider Demographics
NPI:1891430757
Name:DYNAMICARE HEALTH MEDICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:DYNAMICARE HEALTH MEDICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:GASTFRIEND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:855-539-6264
Mailing Address - Street 1:6 LIBERTY SQ # 2102
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-5800
Mailing Address - Country:US
Mailing Address - Phone:855-539-6264
Mailing Address - Fax:617-340-2619
Practice Address - Street 1:399 BOYLSTON ST FL 6
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3325
Practice Address - Country:US
Practice Address - Phone:855-539-6264
Practice Address - Fax:617-340-2619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-04
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty