Provider Demographics
NPI:1992849558
Name:DADA, DANIEL O (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:O
Last Name:DADA
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 1:1120 BELVEDERE RD
Mailing Address - Street 2:
Mailing Address - City:BOOTHWYN
Mailing Address - State:PA
Mailing Address - Zip Code:19061-1523
Mailing Address - Country:US
Mailing Address - Phone:610-358-0588
Mailing Address - Fax:
Practice Address - Street 1:230 E 24TH ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-4634
Practice Address - Country:US
Practice Address - Phone:610-874-6553
Practice Address - Fax:610-874-6653
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030353-E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0031509001OtherKEYSTONE HEALTH PLAN EAST
PA10008OtherKEYSTONE MERCY HEALTH
PA009289130004Medicaid