Provider Demographics
NPI:1952337115
Name:EARDLEY, DANIEL P (DO)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:P
Last Name:EARDLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 PRESIDENT AVE
Mailing Address - Street 2:SUITE 3002
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-5923
Mailing Address - Country:US
Mailing Address - Phone:508-676-3411
Mailing Address - Fax:508-676-0932
Practice Address - Street 1:1030 PRESIDENT AVE
Practice Address - Street 2:SUITE 3002
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-5923
Practice Address - Country:US
Practice Address - Phone:508-676-3411
Practice Address - Fax:508-676-0932
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA73242208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
000368OtherSWH
020013713OtherRAILROAD MED
073242OtherTUFTS
3427308OtherAETNA
B20915902OtherCIGNA
MA3066720Medicaid
MAJ09838OtherBLUE CROSS BLUE SHIELD
5769116 002OtherCIGNA FOR REFERRALS
17 01019OtherUHC
201860OtherBLUE CHIP
RIDE07815Medicaid
8406OtherHPHC
000000021259OtherBMC
0027844OtherNHP
MA007057138OtherRAILROAD MEDICARE
J09838OtherMASS BS
MAJ09838Medicare PIN
RIDE07815Medicaid
MA3066720Medicaid