Basic Information
| Provider Information | |||||||||
| NPI: | 1629360714 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOLLIN | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | ARTHUR | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 63362 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282633362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007826945 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1400 VFW PKWY | ||||||||
| Address2: | |||||||||
| City: | WEST ROXBURY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021324927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6173237700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2011 | ||||||||
| LastUpdateDate: | 11/15/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 2016-00676 | NC | N | Allopathic & Osteopathic Physicians | Urology | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208800000X | 276922 | MA | Y | Allopathic & Osteopathic Physicians | Urology |
No ID Information.