Provider Demographics
NPI:1083683833
Name:DAVIES, DANIEL L (DO)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:L
Last Name:DAVIES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 BORTHWICK AVE
Mailing Address - Street 2:SUITE 202W
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-7156
Mailing Address - Country:US
Mailing Address - Phone:603-433-8434
Mailing Address - Fax:603-436-6608
Practice Address - Street 1:155 BORTHWICK AVE
Practice Address - Street 2:SUITE 202W
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-7156
Practice Address - Country:US
Practice Address - Phone:603-433-8434
Practice Address - Fax:603-436-6608
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000317207R00000X
NH13450207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3082880Medicaid
CTE88441Medicare UPIN
NH3082880Medicaid
P00473725Medicare PIN
CTC003687OtherCHAMPUS
CT040000317CT01OtherBC/BS
CTHAP270OtherOXFORD
CT00100317800OtherBC/BS FAMILY PLAN
CT110004728Medicare ID - Type Unspecified
CT001003178Medicaid
CT534968OtherAETNA
CT782794OtherCONNECTICARE
CT01000317OtherCIGNA
ME432662899Medicaid
CT110110535OtherRAILROAD MEDICARE
NH30225292Medicaid
P00473725Medicare PIN