Provider Demographics
NPI:1316589799
Name:SOSIN, DANIEL MARC (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:MARC
Last Name:SOSIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1454 MIRACERROS LOOP S
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4024
Mailing Address - Country:US
Mailing Address - Phone:678-570-8574
Mailing Address - Fax:
Practice Address - Street 1:1190 S SAINT FRANCIS DR # N-1053
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4173
Practice Address - Country:US
Practice Address - Phone:505-827-2271
Practice Address - Fax:505-827-0013
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-17
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMMD2019-0456207R00000X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine