Healthcare Provider Details

I. General information

NPI: 1073574042
Provider Name (Legal Business Name): DARYL G COLDEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 02/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WALLACE BASHAW JR WAY STE 3002
NEWBURYPORT MA
01950
US

IV. Provider business mailing address

1 WALLACE BASHAW JR WAY STE 3002
NEWBURYPORT MA
01950
US

V. Phone/Fax

Practice location:
  • Phone: 978-997-1550
  • Fax: 978-997-1552
Mailing address:
  • Phone: 978-997-1550
  • Fax: 978-997-1552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number208834
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number208834
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: