Provider Demographics
NPI:1497722532
Name:HARLEY, DANIEL P (MD,MSB,FACS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:P
Last Name:HARLEY
Suffix:
Gender:M
Credentials:MD,MSB,FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4305 MANORWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GLEN ARM
Mailing Address - State:MD
Mailing Address - Zip Code:21057-9126
Mailing Address - Country:US
Mailing Address - Phone:410-686-5887
Mailing Address - Fax:
Practice Address - Street 1:9103 FRANKLIN SQUARE DR
Practice Address - Street 2:SUITE 309
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-3900
Practice Address - Country:US
Practice Address - Phone:410-686-5887
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0034837208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDW311-0001OtherBLUECROSS DC
MD2891OtherBLUECROSS MARYLAND
MD2891Medicare ID - Type Unspecified
MD2891OtherBLUECROSS MARYLAND