Provider Demographics
NPI:1942475678
Name:BATEMAN, DANIEL R (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:R
Last Name:BATEMAN
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 1:350 E CONGRESS PKWY STE C
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-6284
Mailing Address - Country:US
Mailing Address - Phone:815-526-5332
Mailing Address - Fax:669-226-6069
Practice Address - Street 1:350 E CONGRESS PKWY STE C
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-6284
Practice Address - Country:US
Practice Address - Phone:815-526-5332
Practice Address - Fax:669-226-6069
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT04200117892084P0800X, 2084P0805X
NH390200000X2084P0800X
IN01075387A2084P0800X
IL0361620292084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT001132801OtherMEDICARE PIN LINKED TO CVMC
VT001132802OtherMEDICARE PIN LINKED TO CVMC MGP
NH14531OtherNEW HAMPSHIRE MEDICAL LICENSE
VT1016493Medicaid
IN201300990Medicaid
NH14531OtherNEW HAMPSHIRE MEDICAL LICENSE