Provider Demographics
NPI:1982772828
Name:DANIELSON, CARYN A (DO)
Entity Type:Individual
Prefix:DR
First Name:CARYN
Middle Name:A
Last Name:DANIELSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 CHAMBERS DR
Mailing Address - Street 2:SUITE 2200
Mailing Address - City:HOOKSETT
Mailing Address - State:NH
Mailing Address - Zip Code:03106-1981
Mailing Address - Country:US
Mailing Address - Phone:603-641-5386
Mailing Address - Fax:603-641-5387
Practice Address - Street 1:20 CHAMBERS DR
Practice Address - Street 2:SUITE 2200
Practice Address - City:HOOKSETT
Practice Address - State:NH
Practice Address - Zip Code:03106-1981
Practice Address - Country:US
Practice Address - Phone:603-641-5386
Practice Address - Fax:603-641-5387
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2049207R00000X, 208000000X
NH14444207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30226690Medicaid
NHRE5600OtherMEDICARE GROUP
ME000653401Medicare PIN