Provider Demographics
NPI:1194787879
Name:MINGLE, DANIEL B (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:B
Last Name:MINGLE
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 1:219 STREAKED MOUNTAIN ROAD
Mailing Address - Street 2:
Mailing Address - City:SOUTH PARIS
Mailing Address - State:ME
Mailing Address - Zip Code:04281
Mailing Address - Country:US
Mailing Address - Phone:207-441-3064
Mailing Address - Fax:207-624-4319
Practice Address - Street 1:219 STREAKED MOUNTAIN ROAD
Practice Address - Street 2:
Practice Address - City:SOUTH PARIS
Practice Address - State:ME
Practice Address - Zip Code:04281
Practice Address - Country:US
Practice Address - Phone:207-441-3064
Practice Address - Fax:207-624-4319
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME010711207Q00000X
MEMD10711207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEB863323Medicare UPIN
MEMM0419Medicare ID - Type Unspecified
B86323Medicare UPIN