Provider Demographics
NPI:1083433791
Name:CONSOLE, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:CONSOLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O BOX 72
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02334
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:P.O BOX 72
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MA
Practice Address - Zip Code:02334
Practice Address - Country:US
Practice Address - Phone:857-230-8197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA343900000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies