Provider Demographics
NPI:1912117177
Name:PARK, DANIEL H (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:H
Last Name:PARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:200 MILL RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5252
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:480 HAWTHORN ST
Practice Address - Street 2:
Practice Address - City:NORTH DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-3729
Practice Address - Country:US
Practice Address - Phone:508-973-9170
Practice Address - Fax:508-973-9175
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2020-04-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA233890207LP2900X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110083420AMedicaid
MA110083420AMedicaid