Provider Demographics
NPI:1780906321
Name:AINSWORTH, DANIEL J (MMSC, PA-C)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:J
Last Name:AINSWORTH
Suffix:
Gender:M
Credentials:MMSC, PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:55 FRUIT ST
Mailing Address - Street 2:EMERGENCY DEPT.
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2621
Mailing Address - Country:US
Mailing Address - Phone:617-726-2000
Mailing Address - Fax:
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:EMERGENCY DEPT.
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA3943363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant