Individual
DR. DOUGLAS MIDDLETON DAHL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 FRUIT ST, GRB 1102, BOSTON, MA 02114-2621
(617) 726-0875
(617) 726-6131
Mailing address
PO BOX 9142, CHARLESTOWN, MA 02129-9142
(617) 726-0875
(617) 726-6131
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
78119
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3141063
—
MA
01
—
779428
TUFTS HEALTH PLAN
MA
01
—
J31467
BCBS MA
MA
Enumeration date
11/04/2005
Last updated
01/31/2014
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