Provider Demographics
NPI:1962471714
Name:DAHLBEN, SALIN ABRAHAM (MD)
Entity type:Individual
Prefix:DR
First Name:SALIN
Middle Name:ABRAHAM
Last Name:DAHLBEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SALIN
Other - Middle Name:ABRAHAM
Other - Last Name:DAHLBEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:170 MORTON ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-3735
Mailing Address - Country:US
Mailing Address - Phone:617-971-3243
Mailing Address - Fax:617-522-7888
Practice Address - Street 1:25 MOUNT ALVERNIA RD
Practice Address - Street 2:
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-1057
Practice Address - Country:US
Practice Address - Phone:617-244-7933
Practice Address - Fax:617-522-7888
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA45299174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA97776095Medicaid