Provider Demographics
NPI:1194729020
Name:VIG, DANIEL ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ROBERT
Last Name:VIG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2800 BLUE RIDGE RD
Mailing Address - Street 2:STE 503
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6477
Mailing Address - Country:US
Mailing Address - Phone:919-782-8210
Mailing Address - Fax:919-781-4650
Practice Address - Street 1:2800 BLUE RIDGE RD
Practice Address - Street 2:STE 503
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6477
Practice Address - Country:US
Practice Address - Phone:919-782-8210
Practice Address - Fax:919-781-4650
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9901069208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC125GOtherBCBS
NC89125GMedicaid
NC125GOtherBCBS
H01448Medicare UPIN
NC2276524Medicare PIN