Provider Demographics
NPI:1255397816
Name:OSIMANI, DANIEL A (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:A
Last Name:OSIMANI
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:ST.JOE CANDLER- MANAGED CARE DEPT
Mailing Address - Street 2:836 EAST 65TH STREET, BLDG 22
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405
Mailing Address - Country:US
Mailing Address - Phone:912-527-5300
Mailing Address - Fax:912-527-5154
Practice Address - Street 1:1326 EISENHOWER DR BLDG 2
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3928
Practice Address - Country:US
Practice Address - Phone:912-527-5300
Practice Address - Fax:912-527-5154
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2017-02347207RC0000X
VA0101236468207RC0000X
GA079064207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010228921Medicaid
GA79064OtherGA MED LICENSE
WV3810004136Medicaid
WV3810004136Medicaid
VAP00311484Medicare PIN