Provider Demographics
NPI:1386904266
Name:DANIEL L. DELLATORRE MD PC
Entity type:Organization
Organization Name:DANIEL L. DELLATORRE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:DELLATORRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-652-2585
Mailing Address - Street 1:5454 WISCONSIN AVENUE
Mailing Address - Street 2:SUITE 855
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-6948
Mailing Address - Country:US
Mailing Address - Phone:301-652-2585
Mailing Address - Fax:301-652-0380
Practice Address - Street 1:5454 WISCONSIN AVENUE
Practice Address - Street 2:SUITE 855
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-6948
Practice Address - Country:US
Practice Address - Phone:301-652-2585
Practice Address - Fax:301-652-0380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD23131207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty