Provider Demographics
NPI:1578560918
Name:DANIELS, MARC B (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:B
Last Name:DANIELS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 AIRPORT RD
Mailing Address - Street 2:STE 1
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4501
Mailing Address - Country:US
Mailing Address - Phone:207-873-6048
Mailing Address - Fax:207-877-9513
Practice Address - Street 1:40 AIRPORT RD
Practice Address - Street 2:STE 1
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4501
Practice Address - Country:US
Practice Address - Phone:207-873-6048
Practice Address - Fax:207-877-9513
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME013833207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME010543747OtherCOMMERCIAL
ME042733OtherBLUE SHIELD
ME2590268OtherAETNA
ME4693439003OtherCIGNA
ME291100099Medicaid
ME180043171OtherRR MEDICARE
ME4176840001Medicare NSC
MED03859Medicare UPIN
MEMM5407Medicare ID - Type Unspecified