Provider Demographics
NPI:1780748822
Name:MERENSTEIN, DANIEL JON (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JON
Last Name:MERENSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 791775
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279-1775
Mailing Address - Country:US
Mailing Address - Phone:470-276-7931
Mailing Address - Fax:470-276-9046
Practice Address - Street 1:180 MAPLE AVE W
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-5727
Practice Address - Country:US
Practice Address - Phone:703-938-5300
Practice Address - Fax:703-242-0726
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCMD32709207Q00000X
VA0101058211207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G78091Medicare UPIN
001904K32Medicare ID - Type Unspecified
012381M92Medicare ID - Type Unspecified