Provider Demographics
NPI:1124018767
Name:DANIELS, MICHAEL DANIEL (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DANIEL
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:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-8229
Mailing Address - Fax:617-726-3514
Practice Address - Street 1:73 HIGH ST
Practice Address - Street 2:CHARLESTOWN HEALTH CARE CENTER
Practice Address - City:CHARLESTOWN
Practice Address - State:MA
Practice Address - Zip Code:02129-3026
Practice Address - Country:US
Practice Address - Phone:617-724-8229
Practice Address - Fax:617-726-3514
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA329482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAB11416OtherBCBS MA
MA032948OtherTUFTS HEALTH PLAN
B72771Medicare UPIN
MAB11416Medicare ID - Type Unspecified