Provider Demographics
NPI:1366484552
Name:PESCH, DANIEL E (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:E
Last Name:PESCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1477
Mailing Address - Street 2:ONE HOSPITAL ROAD
Mailing Address - City:OAK BLUFFS
Mailing Address - State:MA
Mailing Address - Zip Code:02557-1477
Mailing Address - Country:US
Mailing Address - Phone:508-693-0410
Mailing Address - Fax:508-696-8474
Practice Address - Street 1:ONE HOSPITAL ROAD
Practice Address - Street 2:
Practice Address - City:OAK BLUFFS
Practice Address - State:MA
Practice Address - Zip Code:02557-1477
Practice Address - Country:US
Practice Address - Phone:508-693-0410
Practice Address - Fax:508-696-8474
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036085030207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF98603Medicare UPIN