Provider Demographics
NPI:1770574204
Name:HASSELL, DAYNE DANIEL (MD)
Entity type:Individual
Prefix:
First Name:DAYNE
Middle Name:DANIEL
Last Name:HASSELL
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:PO BOX 85378
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60689-5378
Mailing Address - Country:US
Mailing Address - Phone:336-274-6682
Mailing Address - Fax:336-274-8097
Practice Address - Street 1:1331 N ELM ST STE 200
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-6304
Practice Address - Country:US
Practice Address - Phone:336-274-6682
Practice Address - Fax:336-274-8097
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC98-008932085R0202X
NC98008932085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC26869OtherPARTNERS
NC891164QMedicaid
NC88224OtherMEDCOST
NC300097571OtherRAILROAD MEDICARE
NC300097574OtherRAILROAD MEDICARE
NC1164QOtherBLUE CROSS BLUE SHIELD
NC1607871OtherUNITED HEALTHCARE
NC300097571OtherRAILROAD MEDICARE
NC891164QMedicaid