Provider Demographics
NPI:1720069297
Name:PRATT, DANIEL STEPHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:STEPHAN
Last Name:PRATT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-726-3313
Mailing Address - Fax:617-724-6832
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:BLK 4
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-3313
Practice Address - Fax:617-724-6832
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA74297207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA074297OtherTUFTS HEALTH PLAN
MA3140750Medicaid
MAJ31250OtherBCBS MA
MA074297OtherTUFTS HEALTH PLAN
MA3140750Medicaid