Provider Demographics
NPI:1255395224
Name:OLSON, DANIEL J (DPM)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
Last Name:OLSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3850 WALKER BLVD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-1627
Mailing Address - Country:US
Mailing Address - Phone:814-864-2360
Mailing Address - Fax:814-864-2383
Practice Address - Street 1:3850 WALKER BLVD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-1627
Practice Address - Country:US
Practice Address - Phone:814-864-2360
Practice Address - Fax:814-864-2383
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC005751213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU99951Medicare UPIN
PA079590Medicare ID - Type Unspecified