Basic Information
| Provider Information | |||||||||
| NPI: | 1902432826 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DANESH | ||||||||
| FirstName: | DORREEN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 725 ALBANY ST | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021183549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174145951 | ||||||||
| FaxNumber: | 6174149251 | ||||||||
| Practice Location | |||||||||
| Address1: | 1353 DORCHESTER AVE | ||||||||
| Address2: | |||||||||
| City: | DORCHESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021222932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172883230 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2020 | ||||||||
| LastUpdateDate: | 07/30/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ETLL-567 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.