Provider Demographics
NPI:1396242913
Name:TILLER, DANIEL BISHOP II (DO)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:BISHOP
Last Name:TILLER
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:DANIEL
Other - Middle Name:BISHOP
Other - Last Name:TILLER
Other - Suffix:II
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 37189
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3189
Mailing Address - Country:US
Mailing Address - Phone:571-423-5699
Mailing Address - Fax:571-423-5698
Practice Address - Street 1:6355 WALKER LN STE 500
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-3251
Practice Address - Country:US
Practice Address - Phone:703-797-6970
Practice Address - Fax:703-922-3479
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102205902207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine