MEDICARE: DANIEL WOLFE COLLISON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	8614	NH
2	207ND0101X	MOHS-Micrographic Surgery Physician	8614	NH
3	207NS0135X	Procedural Dermatology Physician	8614	NH
4	208D00000X	General Practice Physician	8614	NH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	070011185	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	4248210	OTHER	AETNA PROVIDER ID
2	E52148	OTHER	HARVARD PILGRIM
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	07502	OTHER	MVP
6	7323862	OTHER	CIGNA NATIONAL PROVIDER
7	008614	OTHER	TUFTS
8	0106540Y0NH01	OTHER	ANTHEM PROVIDER #
9	20234	OTHER	MATTHEW THORNTON HP
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	P378192	OTHER	OXFORD
12	3083123	OTHER	AETNA HMO PROVIDER ID

General Provider Information

NPI Number	:	1235102922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL WOLFE COLLISON M.D.

Provider Business Mailing Address
First Line	:	7 PLEASANT ST
Second Line	:
City	:	HANOVER
State	:	NH
Zip	:	03755-2008
Country	:	US
Telephone Number	:	603-643-5748
Fax Number	:

Provider Business Practice Location Address
First Line	:	7 PLEASANT ST
Second Line	:
City	:	HANOVER
State	:	NH
Zip	:	03755-2008
Country	:	US
Telephone Number	:	603-643-5748
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2006
Last Update Date	:	10/14/2019

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