Healthcare Provider Details

I. General information

NPI: 1235102922
Provider Name (Legal Business Name): DANIEL WOLFE COLLISON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2006
Last Update Date: 10/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 PLEASANT ST
HANOVER NH
03755-2008
US

IV. Provider business mailing address

7 PLEASANT ST
HANOVER NH
03755-2008
US

V. Phone/Fax

Practice location:
  • Phone: 603-643-5748
  • Fax:
Mailing address:
  • Phone: 603-643-5748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number8614
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number8614
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number8614
License Number StateNH
# 4
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number8614
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: