Provider Demographics
NPI:1376570788
Name:MCNICHOL, DANIEL I (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:I
Last Name:MCNICHOL
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 1:238 HUSSON AVE APT 2L
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3258
Mailing Address - Country:US
Mailing Address - Phone:207-945-6545
Mailing Address - Fax:
Practice Address - Street 1:300 MAIN ST.
Practice Address - Street 2:UPSTATE ENT
Practice Address - City:VESTIL
Practice Address - State:NY
Practice Address - Zip Code:13850
Practice Address - Country:US
Practice Address - Phone:607-786-9522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146662207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1534155OtherDIVERS LICENCE ME
010549490OtherFEDERAL ID TAX NO.
102902698OtherPASSPORT NO.
NY146662OtherNY LICENCE
ME135670000Medicaid
ME010823OtherME LICENCE
ME010823OtherME LICENCE
ME1534155OtherDIVERS LICENCE ME
NYRB7758Medicare PIN
010549490OtherFEDERAL ID TAX NO.