Provider Demographics
NPI:1154340420
Name:DOUGLAS, DAVID W (MD)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:W
Last Name:DOUGLAS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:330 LYNNWAY
Mailing Address - Street 2:SUITE 109A
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01901-1706
Mailing Address - Country:US
Mailing Address - Phone:781-593-6005
Mailing Address - Fax:781-593-1370
Practice Address - Street 1:330 LYNNWAY
Practice Address - Street 2:SUITE 109A
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1706
Practice Address - Country:US
Practice Address - Phone:781-593-6005
Practice Address - Fax:781-593-1370
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA150082207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA150082OtherTUFTS HEALTH PLAN
MA710790OtherHARVARD PILGRIM
MA3166341Medicaid
MAB10347002OtherCIGNA
MA186207OtherHEALTHSOURCE
MA0101449OtherUNITED HEALTHCARE
MAJ18455OtherBC/BS
MA2242081OtherAETNA US HEALTHCARE
MA710790OtherHARVARD PILGRIM
MAJ18455OtherBC/BS