Provider Demographics
NPI:1891833398
Name:DELLATORRE, DANIEL L (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:L
Last Name:DELLATORRE
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 1:5454 WISCONSIN AVENUE
Mailing Address - Street 2:SUITE #855
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-6926
Mailing Address - Country:US
Mailing Address - Phone:301-652-2585
Mailing Address - Fax:301-652-0380
Practice Address - Street 1:5454 WISCONSIN AVENUE
Practice Address - Street 2:SUITE #855
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-6926
Practice Address - Country:US
Practice Address - Phone:301-652-2585
Practice Address - Fax:301-652-0380
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD23131207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD033584Medicare ID - Type Unspecified
B92890Medicare UPIN