Provider Demographics
NPI:1992862700
Name:DANIEL HOOBERMAN, MD, LLC
Entity Type:Organization
Organization Name:DANIEL HOOBERMAN, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOBERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-995-5575
Mailing Address - Street 1:34 WELBY RD
Mailing Address - Street 2:STE 205
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02745-1134
Mailing Address - Country:US
Mailing Address - Phone:508-995-5575
Mailing Address - Fax:
Practice Address - Street 1:34 WELBY RD
Practice Address - Street 2:STE 205
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02745-1134
Practice Address - Country:US
Practice Address - Phone:508-995-5575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA499052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM20659Medicare ID - Type Unspecified