Provider Demographics
NPI:1033171442
Name:FERNICOLA, DANIEL J (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:FERNICOLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15005 SHADY GROVE RD
Mailing Address - Street 2:SUITE 340
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-6340
Mailing Address - Country:US
Mailing Address - Phone:240-238-3760
Mailing Address - Fax:240-238-3765
Practice Address - Street 1:15005 SHADY GROVE RD
Practice Address - Street 2:SUITE 340
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-6340
Practice Address - Country:US
Practice Address - Phone:240-238-3760
Practice Address - Fax:240-238-3765
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0056653207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC4787OtherBCBS OF DC GROUP NUMBER
DC0012OtherBCBS OD DC INDIVIDUAL #
MD400180000Medicaid
MDH830OtherBCBS OD MD GROUP NUMBER
MD60979301OtherBCBS OF MD INDIVIDUAL #
MD60979301OtherBCBS OF MD INDIVIDUAL #
DC007078C23Medicare PIN
MDH830OtherBCBS OD MD GROUP NUMBER
MD400180000Medicaid
DC1912021619Medicare PIN