Provider Demographics
NPI:1831132968
Name:TAFFE, DANIEL D (PA)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:D
Last Name:TAFFE
Suffix:
Gender:M
Credentials:PA
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Other - First Name:
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Mailing Address - Street 1:4775 PEACHTREE INDUSTRIAL BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BERKELEY LAKE
Mailing Address - State:GA
Mailing Address - Zip Code:30092-3015
Mailing Address - Country:US
Mailing Address - Phone:800-780-3500
Mailing Address - Fax:770-246-0882
Practice Address - Street 1:4775 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:BERKELEY LAKE
Practice Address - State:GA
Practice Address - Zip Code:30092-3015
Practice Address - Country:US
Practice Address - Phone:800-780-3500
Practice Address - Fax:770-246-0882
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2014-09-02
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Provider Licenses
StateLicense IDTaxonomies
NH347363A00000X
CA51591363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30330538Medicaid
S91516Medicare UPIN
NH30330538Medicaid