Provider Demographics
NPI:1073077939
Name:MADDOCK, DANIEL ALEXANDER (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:ALEXANDER
Last Name:MADDOCK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 SIMMONS RD
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806-2508
Mailing Address - Country:US
Mailing Address - Phone:401-330-8932
Mailing Address - Fax:
Practice Address - Street 1:189 EAGLE ROCK AVE
Practice Address - Street 2:
Practice Address - City:ROSELAND
Practice Address - State:NJ
Practice Address - Zip Code:07068-1347
Practice Address - Country:US
Practice Address - Phone:973-226-3359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-24
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical