Provider Demographics
NPI:1073738142
Name:MAXWELL, DANIEL DAVIS (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:DAVIS
Last Name:MAXWELL
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 1:20265 WATER MARK PL
Mailing Address - Street 2:
Mailing Address - City:POTOMAC FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:20165-5134
Mailing Address - Country:US
Mailing Address - Phone:703-404-3729
Mailing Address - Fax:
Practice Address - Street 1:20265 WATER MARK PL
Practice Address - Street 2:
Practice Address - City:POTOMAC FALLS
Practice Address - State:VA
Practice Address - Zip Code:20165-5134
Practice Address - Country:US
Practice Address - Phone:703-404-3729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101024028174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
D18084Medicare UPIN