David Demaso, MD

Key facts

NPI

1831163658

Entity type

Individual (NPI type 1)

Primary specialty

Child & Adolescent Psychiatry Physician 2084P0804X

License

43777 (MA)

Practice address

300 Longwood Ave
Boston, MA 02115-5724

Phone

(617) 355-6793

NPI assigned

Feb 16, 2006

Sex

Male

Sole proprietor

No

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Boston Childrens Heart Foundation Inc Pediatric Cardiology Physician · Boston, MA · NPI 1982680922
  NPD (past)
• Children'S Hospital Pediatric Associates, Inc Pediatrics Physician · Boston, MA · NPI 1457306664
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Doctor of Medicine

Practice roles

Interoperability endpoints

• Direct secure messaging: ddemaso29280@direct.bostonchildrens.org

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 14, 2014.

{
    "created_epoch": "1140048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405296000000",
    "number": "1831163658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 845628",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022845628",
            "telephone_number": "800-927-0002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 LONGWOOD AVE",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021155724",
            "telephone_number": "617-355-6793"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEMASO",
        "first_name": "DAVID",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-16",
        "last_updated": "2014-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "MA",
            "license": "43777",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30002847",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DD03666",
            "state": "RI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0124966",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1098695",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Shadmehr (Shawn) Demehri, MD, PHD
• Jill Demello, LICSW

All providers in Boston, MA · Child & Adolescent Psychiatry Physician in Massachusetts