Healthcare Provider Details

I. General information

NPI: 1700876018
Provider Name (Legal Business Name): DANIEL LEON MAISON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5457 TWIN KNOLLS RD STE 100
COLUMBIA MD
21045-3263
US

IV. Provider business mailing address

17855 DALLAS PKWY STE 200
DALLAS TX
75287-6857
US

V. Phone/Fax

Practice location:
  • Phone: 410-689-7400
  • Fax:
Mailing address:
  • Phone: 346-376-1702
  • Fax: 224-532-2780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberV0037
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME84214
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301097415
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA62106
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD84710
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: