Provider Demographics
NPI:1508849977
Name:DANIEL, EPHREM (MD)
Entity Type:Individual
Prefix:
First Name:EPHREM
Middle Name:
Last Name:DANIEL
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 1:211 MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-5805
Mailing Address - Country:US
Mailing Address - Phone:410-219-9111
Mailing Address - Fax:410-219-2633
Practice Address - Street 1:211 MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-5805
Practice Address - Country:US
Practice Address - Phone:410-219-9111
Practice Address - Fax:410-219-2633
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD50140208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD055501100Medicaid
MD190979Medicare UPIN
MD119591300Medicaid
119591300OtherMD PHYSICIAN CARE
MDI22144Medicare UPIN
521860379OtherHUMANA
173677OtherANTHEM POCOMOKE
5363139OtherAETNA
E1540005OtherCAREFIRST BLUE CHOICE
255724OtherMAMSI
MDS118K110Medicare PIN
$$$$$$$$$OtherTRICARE STANDARD
054635OtherJHHC
173117OtherANTHEM PRINCESS ANNE
521860379OtherINFORMED