Provider Demographics
NPI:1720159627
Name:BLANDER, DANIEL SETH (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:SETH
Last Name:BLANDER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:75 HERRICK ST
Mailing Address - Street 2:SUITE 219
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-5903
Mailing Address - Country:US
Mailing Address - Phone:978-927-0714
Mailing Address - Fax:978-927-9135
Practice Address - Street 1:75 HERRICK ST
Practice Address - Street 2:SUITE 219
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-5903
Practice Address - Country:US
Practice Address - Phone:978-927-0714
Practice Address - Fax:978-927-9135
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2015-07-13
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Provider Licenses
StateLicense IDTaxonomies
MA234183208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G857300Medicaid
G85343Medicare UPIN