Provider Demographics
NPI:1851340228
Name:SACK, DANIEL BRADLEY (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:BRADLEY
Last Name:SACK
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 1:9 FORWOOD CT
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-1433
Mailing Address - Country:US
Mailing Address - Phone:443-834-6681
Mailing Address - Fax:410-853-7578
Practice Address - Street 1:9 FORWOOD CT
Practice Address - Street 2:
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-1433
Practice Address - Country:US
Practice Address - Phone:443-834-6681
Practice Address - Fax:410-853-7578
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0046344207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP00377751OtherRR MEDICARE
MD411759000Medicaid
MDO136Medicare PIN
MD243HMedicare PIN
MD411759000Medicaid
MD596PMedicare PIN