Provider Demographics
NPI:1376504068
Name:DANIELS, ROBERT L (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:DANIELS
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 1:400 FOOTE AVE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-6800
Mailing Address - Country:US
Mailing Address - Phone:716-484-9194
Mailing Address - Fax:716-484-0115
Practice Address - Street 1:400 FOOTE AVE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-6800
Practice Address - Country:US
Practice Address - Phone:716-484-9194
Practice Address - Fax:716-484-0115
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY131973207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00623143Medicaid
NY040426003855OtherFIDELIS CARE
NY00010262101OtherUNIVERA
NY000508563001OtherBC/BS OF WNY
NYD01578Medicare UPIN
NY00623143Medicaid