Provider Demographics
NPI:1780794131
Name:DANIEL H ERVIN DO PC
Entity type:Organization
Organization Name:DANIEL H ERVIN DO PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:ERVIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:978-874-7368
Mailing Address - Street 1:22 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01473-1535
Mailing Address - Country:US
Mailing Address - Phone:978-874-7368
Mailing Address - Fax:978-874-6111
Practice Address - Street 1:22 SOUTH ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01473-1535
Practice Address - Country:US
Practice Address - Phone:978-874-7368
Practice Address - Fax:978-874-6111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9712917Medicaid
MA9712917Medicaid