Provider Demographics
NPI:1013906262
Name:MUPPIDI, DANIEL J (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:MUPPIDI
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 1:61 LINCOLN STREET
Mailing Address - Street 2:SUITE 208
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702
Mailing Address - Country:US
Mailing Address - Phone:508-628-5400
Mailing Address - Fax:508-628-5410
Practice Address - Street 1:61 LINCOLN ST
Practice Address - Street 2:SUITE 208
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-8264
Practice Address - Country:US
Practice Address - Phone:508-393-0077
Practice Address - Fax:508-628-5410
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA79117174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA79117OtherTUFTS
MA66326OtherHARVARD PILGRIM
MA3140075Medicaid
MAJ16112OtherBLUE CROSS
MAJ16112OtherBLUE CROSS