Provider Demographics
NPI:1376516906
Name:DANIELS, BRET (MD)
Entity Type:Individual
Prefix:
First Name:BRET
Middle Name:
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 1:6415 LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:WRIGHTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17368-9697
Mailing Address - Country:US
Mailing Address - Phone:717-252-1200
Mailing Address - Fax:717-252-0259
Practice Address - Street 1:6415 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:WRIGHTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17368-9697
Practice Address - Country:US
Practice Address - Phone:717-252-1200
Practice Address - Fax:717-252-0259
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD57402L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015801390003Medicaid
PA0824775000OtherAMERIHEALTH
PA20029552 COLUMBIAOtherMERCY
PAPCP P002659OtherGATEWAY
PA1136939OtherKEYSTONE MERCY
PAPCP-000000138812OtherUNISON
PA80100827OtherRAILROAD MEDICARE
PA0015801390008Medicaid
PA50049084OtherCAPITAL BLUE CROSS
PA5067439OtherAETNA PPO
PA800768OtherHIGHMARK BLUE SHIELD
PA0015801390007Medicaid
PA20030976 WRIGHTSOtherMERCY
PA3264144OtherAETNA HMO
PA0015801390007Medicaid