Provider Demographics
NPI:1376532275
Name:ERVIN, DANIEL HUNTER (DO)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:HUNTER
Last Name:ERVIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01473-1535
Mailing Address - Country:US
Mailing Address - Phone:978-874-7368
Mailing Address - Fax:978-874-6111
Practice Address - Street 1:22 SOUTH ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01473-1535
Practice Address - Country:US
Practice Address - Phone:978-874-7368
Practice Address - Fax:978-874-6111
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-14
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA80887207Y00000X, 208200000X
MA231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
19508OtherHARVARD / PILGRIM
1003021OtherUNITED HEALTHCARE
986254OtherNETWORK HEALTH
3256567OtherCIGNA
35219192OtherAETNA
MA3140245Medicaid
MAJ16123OtherBCBS
23782OtherFALLON COMMUNITY HEALTH
291708409OtherTRICARE
0034554OtherNEIGHBORHOOD HEALTH PLAN
MA080887OtherTUFTS
P00079664OtherRAILROAD MEDICARE
291708409OtherTRICARE
1003021OtherUNITED HEALTHCARE