Provider Demographics
NPI:1508876871
Name:KOELLIKER, DANIEL DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:DAVID
Last Name:KOELLIKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5 LIGHTHOUSE LN
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806-2829
Mailing Address - Country:US
Mailing Address - Phone:401-245-2389
Mailing Address - Fax:
Practice Address - Street 1:2014 WASHINGTON ST
Practice Address - Street 2:PATHOLOGY DEPARTMENT, NEWTON-WELLESLEY HOSPITAL
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462-1607
Practice Address - Country:US
Practice Address - Phone:617-243-6140
Practice Address - Fax:617-243-5809
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA79822207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Not Answered207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000021384OtherBOSTON CITY HEALTH NET
MA3126374Medicaid
34725OtherHARVARD-PILGRIM HEALTH
34802OtherHARVARD PILGRIM HEALTH
34802OtherHPHCFIRST SENIORITY
803550OtherSECURE HORIZONS
737777OtherTUFTS HEALTH PLAN POS
KOJ30752OtherBC/BS MASS
MA3126374Medicaid
34802OtherHARVARD PILGRIM HEALTH