Healthcare Provider Details

I. General information

NPI: 1164568655
Provider Name (Legal Business Name): DANE R FLIEDNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 GRUBB RD STE 123
WILMINGTON DE
19810-4711
US

IV. Provider business mailing address

PO BOX 37142
BELFAST ME
04915-1213
US

V. Phone/Fax

Practice location:
  • Phone: 302-304-3417
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA76363
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberM5161
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC1-0024271
License Number StateDE
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberCDRH.0063064
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: