Provider Demographics
NPI:1912911769
Name:LEDERER, DANIEL H (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:H
Last Name:LEDERER
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 1:345 BLACKSTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-4800
Mailing Address - Country:US
Mailing Address - Phone:401-455-6200
Mailing Address - Fax:401-455-6309
Practice Address - Street 1:345 BLACKSTONE BLVD
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-4800
Practice Address - Country:US
Practice Address - Phone:401-455-6200
Practice Address - Fax:401-455-6309
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD04938207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI0000021016OtherBLUE SHIELD OF RHODE ISLAND
RI0402683OtherUNITED HEALTHCARE
RI119021016OtherMEDICARE OF RHODE ISLAND
RI001290OtherBLUE CHIP
RI406113OtherTUFTS HEALTH PLAN
RI7003866OtherMEDICAID OF RHODE ISLAND
RI110206706OtherRAILROAD MEDICARE
RI119021016OtherMEDICARE OF RHODE ISLAND