Provider Demographics
NPI:1669700399
Name:DANIEL HEXTER MD PA
Entity type:Organization
Organization Name:DANIEL HEXTER MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HEXTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-266-9694
Mailing Address - Street 1:122 DEFENSE HWY
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7069
Mailing Address - Country:US
Mailing Address - Phone:443-481-6467
Mailing Address - Fax:443-481-6515
Practice Address - Street 1:130 LOVE POINT RD
Practice Address - Street 2:SUITE 107
Practice Address - City:STEVENSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21666-2132
Practice Address - Country:US
Practice Address - Phone:410-266-9694
Practice Address - Fax:410-266-9695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-18
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD418967801Medicaid
MD240592Medicare PIN