Provider Demographics
NPI:1285698936
Name:AGHASSI, DAVID SHAUN (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:SHAUN
Last Name:AGHASSI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:65 WALNUT STREET
Mailing Address - Street 2:SUITE 520
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481
Mailing Address - Country:US
Mailing Address - Phone:781-237-3500
Mailing Address - Fax:781-237-7867
Practice Address - Street 1:65 WALNUT STREET
Practice Address - Street 2:SUITE 520
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481
Practice Address - Country:US
Practice Address - Phone:781-237-3500
Practice Address - Fax:781-237-7867
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA157066207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G67671Medicare UPIN
MAA23559Medicare ID - Type Unspecified