Provider Demographics
NPI:1437294584
Name:DANA, MAURICE F (MD)
Entity Type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:F
Last Name:DANA
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:PO BOX 1689
Mailing Address - Street 2:285 HOWARD BLVD.
Mailing Address - City:NEWPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28570-1689
Mailing Address - Country:US
Mailing Address - Phone:252-223-4054
Mailing Address - Fax:252-223-2388
Practice Address - Street 1:285 HOWARD BLVD.
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:NC
Practice Address - Zip Code:28570-1689
Practice Address - Country:US
Practice Address - Phone:252-223-4054
Practice Address - Fax:252-223-2388
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30120207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8926870Medicaid
C83446Medicare UPIN
NCB915C355Medicare PIN
NC8926870Medicaid