Provider Demographics
NPI:1174797468
Name:BROCKS, DANIEL C (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:C
Last Name:BROCKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:464 HILLSIDE AVE
Mailing Address - Street 2:STE 205
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-1228
Mailing Address - Country:US
Mailing Address - Phone:781-726-7337
Mailing Address - Fax:781-726-7311
Practice Address - Street 1:464 HILLSIDE AVE STE 205
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-1228
Practice Address - Country:US
Practice Address - Phone:781-726-7505
Practice Address - Fax:845-896-0246
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA270838207W00000X
NY239164-1207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00398632Medicaid
NYA4000Medicare UPIN
NY290461Medicare Oscar/Certification
NY00398632Medicaid