Provider Demographics
NPI:1134239767
Name:SHREVE, DANIEL T (MD)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:T
Last Name:SHREVE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DANIEL
Other - Middle Name:T
Other - Last Name:SHREVE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:47 HAZARD AVE
Mailing Address - Street 2:DANIEL T SHREVE MD INC
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914
Mailing Address - Country:US
Mailing Address - Phone:401-434-9100
Mailing Address - Fax:401-434-4732
Practice Address - Street 1:47 HAZARD AVE
Practice Address - Street 2:DANIEL T SHREVE MD INC
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914
Practice Address - Country:US
Practice Address - Phone:401-434-9100
Practice Address - Fax:401-434-4732
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIL3558207Q00000X
RIMD03558207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9001447Medicaid
RI9001447Medicaid
C90179Medicare UPIN