Provider Demographics
NPI:1215902226
Name:NADEAU, DANIEL ALLEN (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:ALLEN
Last Name:NADEAU
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 1:510 SUPERIOR AVE STE 200B
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3665
Mailing Address - Country:US
Mailing Address - Phone:949-791-3001
Mailing Address - Fax:949-791-3096
Practice Address - Street 1:510 SUPERIOR AVE STE 150
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3663
Practice Address - Country:US
Practice Address - Phone:949-791-3001
Practice Address - Fax:949-791-3096
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11513207R00000X, 207RE0101X
ME013924207RE0101X
CAG88930207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30202039Medicaid
NH30202039Medicaid
CAHN143ZMedicare PIN
NHRE6613Medicare ID - Type Unspecified