Active NPI
Douglas Walter Eng, EDD
- Exercise & Sports Psychologist
- Medford, MA
National Provider Identifier
1801742325
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Exercise & Sports Psychologist
- License
- 961
- Practice address
- 30 Revere Beach Pkwy Apt 302
Medford, MA 02155-5162 - Phone
- (617) 281-8368
- NPI assigned
- Mar 6, 2026
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Exercise & Sports Psychologist | 103TE1100X | 961 | MA | Primary |
Addresses
Primary practice location
30 Revere Beach Pkwy Apt 302
Medford, MA 02155-5162
Mailing address
30 Revere Beach Pkwy Apt 302
Medford, MA 02155-5162
Phone (617) 281-8368
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 961 | MA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1772755200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1772755200000",
"number": "1801742325",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30 REVERE BEACH PKWY APT 302",
"city": "MEDFORD",
"state": "MA",
"postal_code": "021555162",
"telephone_number": "617-281-8368"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30 REVERE BEACH PKWY APT 302",
"city": "MEDFORD",
"state": "MA",
"postal_code": "021555162",
"telephone_number": "617-281-8368"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ENG",
"first_name": "DOUGLAS",
"middle_name": "WALTER",
"name_prefix": "Dr.",
"credential": "EDD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2026-03-06",
"last_updated": "2026-03-06",
"certification_date": "2026-03-06",
"status": "A"
},
"taxonomies": [
{
"code": "103TE1100X",
"taxonomy_group": "",
"desc": "Psychologist, Exercise & Sports",
"state": "MA",
"license": "961",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Medford, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.