Provider Demographics
NPI:1467478230
Name:DWYER, DANIEL PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:PATRICK
Last Name:DWYER
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 1:4810 S CROATAN HWY
Mailing Address - Street 2:STE 250
Mailing Address - City:NAGS HEAD
Mailing Address - State:NC
Mailing Address - Zip Code:27959-8508
Mailing Address - Country:US
Mailing Address - Phone:252-261-4885
Mailing Address - Fax:252-441-2641
Practice Address - Street 1:4810 S CROATAN HWY
Practice Address - Street 2:STE 250
Practice Address - City:NAGS HEAD
Practice Address - State:NC
Practice Address - Zip Code:27959-8508
Practice Address - Country:US
Practice Address - Phone:252-261-4885
Practice Address - Fax:252-441-2641
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC9400478207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8929605Medicaid
NC29605OtherBCBS OF NC
NC29605OtherBCBS OF NC
NC2203135Medicare ID - Type Unspecified