Basic Information
| Provider Information | |||||||||
| NPI: | 1932148020 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DICKASON | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 790 BOSTON RD | ||||||||
| Address2: | |||||||||
| City: | BILLERICA | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018215938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7815058700 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 790 BOSTON RD | ||||||||
| Address2: | |||||||||
| City: | BILLERICA | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018215938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7815058700 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2006 | ||||||||
| LastUpdateDate: | 11/28/2017 | ||||||||
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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 | 207R00000X | 216433 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0200X | 216433 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No ID Information.