1508876871 NPI number — DR. DANIEL DAVID KOELLIKER M.D.

Table of content: REBECCA LEE LMFT (NPI 1477709202)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508876871 NPI number — DR. DANIEL DAVID KOELLIKER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOELLIKER
Provider First Name:
DANIEL
Provider Middle Name:
DAVID
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508876871
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 LIGHTHOUSE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BARRINGTON
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02806-2829
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-245-2389
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2014 WASHINGTON ST
Provider Second Line Business Practice Location Address:
PATHOLOGY DEPARTMENT, NEWTON-WELLESLEY HOSPITAL
Provider Business Practice Location Address City Name:
NEWTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02462-1607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-243-6140
Provider Business Practice Location Address Fax Number:
617-243-5809
Provider Enumeration Date:
08/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZC0500X , with the licence number:  79822 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207ZP0102X , with the licence number: 79822 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000021384 . This is a "BOSTON CITY HEALTH NET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3126374 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 34725 . This is a "HARVARD-PILGRIM HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 34802 . This is a "HARVARD PILGRIM HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 34802 . This is a "HPHCFIRST SENIORITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 803550 . This is a "SECURE HORIZONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 737777 . This is a "TUFTS HEALTH PLAN POS" identifier . This identifiers is of the category "OTHER".
  • Identifier: KOJ30752 . This is a "BC/BS MASS" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com