Provider Demographics
NPI:1558397240
Name:MCCULLOUGH, DANIEL JOHN III (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JOHN
Last Name:MCCULLOUGH
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:900 CUMMINGS CTR
Mailing Address - Street 2:107 W
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6198
Mailing Address - Country:US
Mailing Address - Phone:978-927-1859
Mailing Address - Fax:978-927-2388
Practice Address - Street 1:900 CUMMINGS CTR
Practice Address - Street 2:107W
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6198
Practice Address - Country:US
Practice Address - Phone:978-927-1859
Practice Address - Fax:978-927-2388
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2012-01-23
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Provider Licenses
StateLicense IDTaxonomies
MA204646207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0115631Medicaid
G50641Medicare UPIN
MA2731457Medicare ID - Type Unspecified