Provider Demographics
NPI:1548383748
Name:CORREA DE SA, DANIEL DANTAS (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:DANTAS
Last Name:CORREA DE SA
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:111 COLCHESTER AVE
Mailing Address - Street 2:UVM MEDICAL CENTER - CARDIOLOGY
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-1473
Mailing Address - Country:US
Mailing Address - Phone:802-847-4600
Mailing Address - Fax:802-847-2533
Practice Address - Street 1:111 COLCHESTER AVE
Practice Address - Street 2:UVM MEDICAL CENTER - CARDIOLOGY
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1473
Practice Address - Country:US
Practice Address - Phone:802-847-4600
Practice Address - Fax:802-847-2533
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN50796207R00000X
VT042.0013407207RC0001X, 207RC0000X
IL036132780207RC0001X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN110011986Medicare PIN
IL214881Medicare Oscar/Certification