Provider Demographics
NPI:1922046721
Name:MISKULIN, DANA C (MD)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:C
Last Name:MISKULIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CHAPEL ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-1901
Mailing Address - Country:US
Mailing Address - Phone:617-628-0910
Mailing Address - Fax:
Practice Address - Street 1:800 WASHINGTON ST
Practice Address - Street 2:BOX 391
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1552
Practice Address - Country:US
Practice Address - Phone:617-636-5866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA213820207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0026924OtherNEIGHBORHOOD HEALTH PLAN
MA2809283OtherAETNA/US HEALTHCARE
MA31-00287OtherUNITED HEALTHCARE
MAA34171Medicaid
MACIGNA SCP 5368325003OtherCIGNA SCP
MA213280OtherTUFTS
MAHCVM TAX ID# 04-2743OtherHCVM TAX ID# 04-2743894
MA7356345OtherAETNA/US HEALTHCA NON-HMO
MA1454175002OtherCIGNA/HEALTHSOURCE PRATT
MA10322OtherHARVARD PILGRIM
MAJ24821OtherHMO BLUE / BLUE CARE ELEC
MAJ24821OtherBLUE SHIELD INDEMNIT
MA04-2743894OtherUNICARE
MA1454175002OtherCIGNA/HEALTHSOURCE PRATT
MA0168904Medicare ID - Type Unspecified