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Individual

ANNE ELLSWORTH DANTZLER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
940 BELMONT ST, BLDG 2, 3RD FLOOR, WARD 2-3-B OR A310, VA BOSTON HEALTHCARE SYSTEM, BROCKTON DIVISION, BROCKTON, MA 02301-5596
(774) 826-1408
(774) 826-3217
Mailing address
250 HAMMOND POND PKWY, 410N, CHESTNUT HILL, MA 02467-1545
(617) 699-7642

Taxonomy

Speciality
Code
Description
License number
State
2084F0202X
Forensic Psychiatry Physician
44539
MA
2084P0015X
Psychosomatic Medicine Physician
44539
MA
2084P0800X
Psychiatry Physician
Primary
44539
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
J16409
BLUE CROSS/BLUE SHIELD
MA
Enumeration date
10/10/2006
Last updated
08/09/2012
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