Provider Demographics
NPI:1235102922
Name:COLLISON, DANIEL WOLFE (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:WOLFE
Last Name:COLLISON
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 1:7 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03755-2008
Mailing Address - Country:US
Mailing Address - Phone:603-643-5748
Mailing Address - Fax:
Practice Address - Street 1:7 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:NH
Practice Address - Zip Code:03755-2008
Practice Address - Country:US
Practice Address - Phone:603-643-5748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-11
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH8614207N00000X, 207ND0101X, 207NS0135X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
4248210OtherAETNA PROVIDER ID
E52148OtherHARVARD PILGRIM
VT0002051Medicaid
070011185OtherRAILROAD MEDICARE
07502OtherMVP
7323862OtherCIGNA NATIONAL PROVIDER
008614OtherTUFTS
0106540Y0NH01OtherANTHEM PROVIDER #
20234OtherMATTHEW THORNTON HP
NH80002051Medicaid
P378192OtherOXFORD
3083123OtherAETNA HMO PROVIDER ID
20234OtherMATTHEW THORNTON HP
E52148Medicare UPIN