Provider Demographics
NPI:1942384417
Name:O'BRIEN, DANIEL K (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:K
Last Name:O'BRIEN
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 1:324 GANNETT DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-3266
Mailing Address - Country:US
Mailing Address - Phone:207-482-7800
Mailing Address - Fax:
Practice Address - Street 1:489 STATE ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6616
Practice Address - Country:US
Practice Address - Phone:207-973-8150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD154122085R0202X
ME0154122085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEH26118Medicare UPIN
ME0007396153OtherAETNA/USHC
ME038922OtherANTHEM
ME2368691OtherAETNA
ME300117639Medicare ID - Type UnspecifiedRAILROAD
MEMM851001Medicare PIN
MEMM8510Medicare ID - Type Unspecified
MEH26118OtherHPHC
MEM183524OtherCIGNA
ME275950099Medicaid