Provider Demographics
NPI:1245262773
Name:DREYFUSS, DANIEL (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:DREYFUSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 MARION ST APT 14
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-4466
Mailing Address - Country:US
Mailing Address - Phone:857-234-9422
Mailing Address - Fax:617-879-0388
Practice Address - Street 1:25 MARION ST APT 14
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-4466
Practice Address - Country:US
Practice Address - Phone:857-234-9422
Practice Address - Fax:617-879-0388
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA453842084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1245262773Medicare PIN