Provider Demographics
NPI:1053536391
Name:BRESLIN, DANIEL LAWRENCE (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:LAWRENCE
Last Name:BRESLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:365 EAST ST
Mailing Address - Street 2:TEWKSBURY HOSPITAL
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-1950
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:365 EAST ST
Practice Address - Street 2:TEWKSBURY HOSPITAL
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876-1950
Practice Address - Country:US
Practice Address - Phone:978-851-7321
Practice Address - Fax:978-851-1028
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA601382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3049124Medicaid
MABR J08113OtherBCBS OF MASSACHUSETTS
MABR J08113OtherBCBS OF MASSACHUSETTS
MAJ08113Medicare ID - Type Unspecified