Provider Demographics
NPI:1518056324
Name:PHELAN, DANIEL T (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:T
Last Name:PHELAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1367 WASHINGTON AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12206-1043
Mailing Address - Country:US
Mailing Address - Phone:518-489-2666
Mailing Address - Fax:518-489-5933
Practice Address - Street 1:1367 WASHINGTON AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-1043
Practice Address - Country:US
Practice Address - Phone:518-489-2666
Practice Address - Fax:518-489-5933
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY219592-3207XX0005X, 207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10086280OtherCDPHP
NY02563266Medicaid
NY000416120001OtherBS NENY
NY371186OtherMVP
NY7667619OtherAETNA
NY580F71OtherEMPIRE BC
I13098Medicare UPIN
NY371186OtherMVP