Individual
DR. DAVID BRANDEIS HERZOG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2 LONGFELLOW PL, SUITE 200, BOSTON, MA 02114-2437
(617) 724-0799
(617) 726-1595
Mailing address
2 LONGFELLOW PL, SUITE 200, BOSTON, MA 02114-2437
(617) 726-8470
(617) 726-1595
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
38347
MA
2084P0800X
Psychiatry Physician
Primary
38347
MA
2084P0804X
Child & Adolescent Psychiatry Physician
38347
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0107433
—
MA
01
—
700650
TUFTS HEALTH PLAN
MA
01
—
M09907
BCBS MA
MA
Enumeration date
11/09/2005
Last updated
08/12/2009
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