Provider Demographics
NPI:1972619864
Name:REGAN, DANIEL LEONARD (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:LEONARD
Last Name:REGAN
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 1:1526 ATWOOD AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919
Mailing Address - Country:US
Mailing Address - Phone:401-273-9400
Mailing Address - Fax:401-273-2339
Practice Address - Street 1:1526 ATWOOD AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919
Practice Address - Country:US
Practice Address - Phone:401-273-9400
Practice Address - Fax:401-273-2339
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD06534207QA0401X
RIRI6534207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7007002Medicaid
RI7007002Medicaid
007007002Medicare ID - Type Unspecified