Provider Demographics
NPI:1558680959
Name:CHEVY, DANIEL MARCUS (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:MARCUS
Last Name:CHEVY
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 1:65-1267 KAWAIHAE RD
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-7345
Mailing Address - Country:US
Mailing Address - Phone:808-881-4745
Mailing Address - Fax:
Practice Address - Street 1:65-1267 KAWAIHAE RD
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-7345
Practice Address - Country:US
Practice Address - Phone:808-881-4745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-25
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2017-00764207R00000X
NH16262207R00000X
MTMED-PHYS-LIC-87668207R00000X
HIMD-18272207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3088917Medicaid
NH3088917Medicaid
HIH106847Medicare PIN