Provider Demographics
NPI:1558345918
Name:DANIEL, JOHN CHRISTOPHER (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:CHRISTOPHER
Last Name:DANIEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:ROUTE 12 BLDG 449
Mailing Address - Street 2:NAVAL HEALTH CARE NEW ENGLAND ATTN PROFESSIONAL AFFAIRS
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06349-5600
Mailing Address - Country:US
Mailing Address - Phone:860-694-2377
Mailing Address - Fax:860-694-2590
Practice Address - Street 1:TROUT AVE BLDG 141
Practice Address - Street 2:NAVAL SUBMARINE MEDICAL RESEARCH LABORATORY
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06349-5900
Practice Address - Country:US
Practice Address - Phone:860-694-2377
Practice Address - Fax:860-694-3590
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-30
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD034609E207Q00000X, 207QA0000X, 2083A0100X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
Not Answered2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN