Basic Information
| Provider Information | |||||||||
| NPI: | 1003349234 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOLIN | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D., PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 75 FRANCIS ST. | ||||||||
| Address2: | DEPARTMENT OF PATHOLOGY | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177326913 | ||||||||
| FaxNumber: | 6172779015 | ||||||||
| Practice Location | |||||||||
| Address1: | 75 FRANCIS ST. | ||||||||
| Address2: | DEPARTMENT OF PATHOLOGY | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177326913 | ||||||||
| FaxNumber: | 6172779015 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2017 | ||||||||
| LastUpdateDate: | 08/23/2018 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 11/09/2017 | ||||||||
| NPIReactivationDate: | 12/11/2017 | ||||||||
| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0101X | 98587 | ZZ | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology | 207ZP0101X | MD459643 | PA | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology | 207ZP0101X | 270171 | MA | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology | 207ZP0101X | 276615 | MA | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology |
No ID Information.