Provider Demographics
NPI:1669960555
Name:HERRICK, DANIEL BLAKELEY (MD, PHD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:BLAKELEY
Last Name:HERRICK
Suffix:
Gender:
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 CAMPUS DR STE A
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-7229
Mailing Address - Country:US
Mailing Address - Phone:207-885-0011
Mailing Address - Fax:207-885-5851
Practice Address - Street 1:92 CAMPUS DR STE A
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-7229
Practice Address - Country:US
Practice Address - Phone:207-885-0011
Practice Address - Fax:207-885-5851
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD29111207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery