Provider Demographics
NPI:1598147092
Name:FOSSELMAN, DANIEL S (DO)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:S
Last Name:FOSSELMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4018 N HAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-8431
Mailing Address - Country:US
Mailing Address - Phone:614-618-0017
Mailing Address - Fax:614-635-9229
Practice Address - Street 1:4018 N HAMPTON DR
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-8431
Practice Address - Country:US
Practice Address - Phone:614-618-0017
Practice Address - Fax:614-635-9229
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-22
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.012407207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0342372Medicaid