Provider Demographics
NPI:1487114377
Name:BANASZEK, DANIEL (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:BANASZEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 WASHINGTON STREET
Mailing Address - Street 2:SUITE 341
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02462-1625
Mailing Address - Country:US
Mailing Address - Phone:617-964-0024
Mailing Address - Fax:617-964-6374
Practice Address - Street 1:2000 WASHINGTON STREET
Practice Address - Street 2:SUITE 341
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462-1625
Practice Address - Country:US
Practice Address - Phone:617-964-0024
Practice Address - Fax:617-964-6374
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA278086207XS0117X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine