Provider Demographics
NPI:1205902442
Name:FASSETT, DANIEL (MD, MBA)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:FASSETT
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Gender:M
Credentials:MD, MBA
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Mailing Address - Street 1:833 CHESTNUT ST STE 520
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4430
Mailing Address - Country:US
Mailing Address - Phone:609-677-7003
Mailing Address - Fax:267-339-3761
Practice Address - Street 1:1141 PATTERSON TER
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2203
Practice Address - Country:US
Practice Address - Phone:844-407-4070
Practice Address - Fax:407-743-3050
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2022-07-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036117618207T00000X
FLME154265207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-117618OtherSTATE LICENSE