Provider Demographics
NPI:1922210095
Name:ROSENN, DANIEL W (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:W
Last Name:ROSENN
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 1:310 WASHINGTON ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-4949
Mailing Address - Country:US
Mailing Address - Phone:781-237-3134
Mailing Address - Fax:781-237-3410
Practice Address - Street 1:310 WASHINGTON ST
Practice Address - Street 2:SUITE 203
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-4949
Practice Address - Country:US
Practice Address - Phone:781-237-3134
Practice Address - Fax:781-237-3410
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA361972084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAB07156Medicare ID - Type Unspecified
A58306Medicare UPIN