Provider Demographics
NPI:1306871900
Name:COULTER, DAVID L (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:COULTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:300 LONGWOOD AVE
Mailing Address - Street 2:FEGAN 11
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5724
Mailing Address - Country:US
Mailing Address - Phone:617-355-2758
Mailing Address - Fax:617-730-0285
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:FEGAN 11
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-2758
Practice Address - Fax:617-730-0285
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-09-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA55654208000000X, 2084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics