Provider Demographics
NPI:1831145598
Name:HENSELL, DANIEL O (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:O
Last Name:HENSELL
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 1:2230 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-3950
Mailing Address - Country:US
Mailing Address - Phone:215-952-0792
Mailing Address - Fax:215-952-0794
Practice Address - Street 1:3401 N BROAD ST
Practice Address - Street 2:OUTPT BLDG, 6TH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5103
Practice Address - Country:US
Practice Address - Phone:215-952-0792
Practice Address - Fax:215-952-0794
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD016070E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006697690004Medicaid
PA0006697690004Medicaid
PA031916Medicare ID - Type Unspecified
NJ052846Medicare ID - Type Unspecified