Provider Demographics
NPI:1619071842
Name:WORONOW, DANIEL I (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:I
Last Name:WORONOW
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 1:12609 CELTIC CT
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3769
Mailing Address - Country:US
Mailing Address - Phone:301-367-3856
Mailing Address - Fax:
Practice Address - Street 1:12609 CELTIC CT
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3769
Practice Address - Country:US
Practice Address - Phone:301-367-3856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD23805207RI0011X
DC13973207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD465161800Medicaid
DC024671200Medicaid
5878-0001OtherCAREFIRST BLUECROSS BLUES