Provider Demographics
NPI:1831149905
Name:DANIELS, MARK (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:DANIELS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5096
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98227-5096
Mailing Address - Country:US
Mailing Address - Phone:360-734-2700
Mailing Address - Fax:360-734-8362
Practice Address - Street 1:2979 SQUALICUM PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1811
Practice Address - Country:US
Practice Address - Phone:360-734-2700
Practice Address - Fax:360-734-8362
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00039185207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5104548OtherAETNA
WA8265027Medicaid
WAGAB26184OtherMEDICARE PIN FOR SJMC
AKMD2373WMedicaid
WA1831149905Medicaid
WA0279972OtherL&I AND CRIME VICTIMS FOR PHMG
WA5442DAOtherREGENCE BLUE SHIELD
WA82107OtherL&I AND CRIME VICTIMS FOR SJMC
WAG008OtherTRI WEST (TRICARE)
WA060066730OtherRAILROAD MEDICARE
WA0279972OtherL&I AND CRIME VICTIMS FOR PHMG
AKMD2373WMedicaid
WAG89000990Medicare PIN