Provider Demographics
NPI:1134126469
Name:DADURIAN, DANIELA (MD)
Entity Type:Individual
Prefix:
First Name:DANIELA
Middle Name:
Last Name:DADURIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 S QUADRILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-5305
Mailing Address - Country:US
Mailing Address - Phone:561-366-9773
Mailing Address - Fax:561-366-8665
Practice Address - Street 1:320 S QUADRILLE BLVD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-5305
Practice Address - Country:US
Practice Address - Phone:561-366-9773
Practice Address - Fax:561-366-8665
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2011-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70074207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G64947Medicare UPIN
FL32815YMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER