Provider Demographics
NPI:1740748235
Name:LEARY, DANIEL MICHAEL (PA-C)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:MICHAEL
Last Name:LEARY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3455 MAIN ST STE 5
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1142
Mailing Address - Country:US
Mailing Address - Phone:413-788-0532
Mailing Address - Fax:413-562-1154
Practice Address - Street 1:3455 MAIN ST STE 5
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1142
Practice Address - Country:US
Practice Address - Phone:413-733-9600
Practice Address - Fax:413-732-6534
Is Sole Proprietor?:No
Enumeration Date:2019-03-04
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA01127363A00000X
MAPA7337363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty