Provider Demographics
NPI:1164469946
Name:SISKIND, DAN J (MD BS MPH)
Entity type:Individual
Prefix:DR
First Name:DAN
Middle Name:J
Last Name:SISKIND
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Gender:M
Credentials:MD BS MPH
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Mailing Address - Street 1:3313 WASHINGTON ST
Mailing Address - Street 2:SUITE 1 PACT
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130
Mailing Address - Country:US
Mailing Address - Phone:617-971-9400
Mailing Address - Fax:617-971-9670
Practice Address - Street 1:3313 WASHINGTON ST
Practice Address - Street 2:SUITE 1 PACT
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130
Practice Address - Country:US
Practice Address - Phone:617-971-9400
Practice Address - Fax:617-971-9670
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA2233532084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2115174Medicaid
MS0586276AOtherMA CONTROLLED SUBSTANCE
MS0586276AOtherMA CONTROLLED SUBSTANCE
BS9253852OtherDEA