Provider Demographics
NPI:1912907387
Name:DANIELS, MICHAEL O (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:O
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 1:303 N BALTIMORE AVE
Mailing Address - Street 2:
Mailing Address - City:MT HOLLY SPRINGS
Mailing Address - State:PA
Mailing Address - Zip Code:17065-1607
Mailing Address - Country:US
Mailing Address - Phone:717-486-8550
Mailing Address - Fax:717-486-3022
Practice Address - Street 1:303 N BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:MT HOLLY SPRINGS
Practice Address - State:PA
Practice Address - Zip Code:17065-1607
Practice Address - Country:US
Practice Address - Phone:717-486-8550
Practice Address - Fax:717-486-3022
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035872E207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1012907387OtherNPI
PA0010477270001Medicaid
C32121Medicare UPIN
154585G8QMedicare ID - Type Unspecified