Healthcare Provider Details

I. General information

NPI: 1831137819
Provider Name (Legal Business Name): DANIEL M THAILER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 RANDOLPH RD
CHARLOTTE NC
28211-1018
US

IV. Provider business mailing address

21 SHIRLEY TERRACE
KINNELON NJ
07405
US

V. Phone/Fax

Practice location:
  • Phone: 973-492-8402
  • Fax: 828-327-4245
Mailing address:
  • Phone: 973-493-2605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2010-00405
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: