Basic Information
Provider Information
NPI: 1790705184
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ANNINO
FirstName: DONALD
MiddleName: J
NamePrefix:  
NameSuffix:  
Credential: MD DMD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 111 CYPRESS ST
Address2:  
City: BROOKLINE
State: MA
PostalCode: 024456002
CountryCode: US
TelephoneNumber: 8573070896
FaxNumber:  
Practice Location
Address1: 45 FRANCIS ST
Address2: BRIGHAM AND WOMENS HOSPITAL DIVISION OF OTOLARYNGOLOGY
City: BOSTON
State: MA
PostalCode: 02115
CountryCode: US
TelephoneNumber: 6175256533
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/20/2006
LastUpdateDate: 08/03/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Y00000X77957MAY Allopathic & Osteopathic PhysiciansOtolaryngology 

No ID Information.


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