Healthcare Provider Details

I. General information

NPI: 1912907387
Provider Name (Legal Business Name): MICHAEL O DANIELS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 11/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 N BALTIMORE AVE
MT HOLLY SPRINGS PA
17065-1607
US

IV. Provider business mailing address

303 N BALTIMORE AVE
MT HOLLY SPRINGS PA
17065-1607
US

V. Phone/Fax

Practice location:
  • Phone: 717-486-8550
  • Fax: 717-486-3022
Mailing address:
  • Phone: 717-486-8550
  • Fax: 717-486-3022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD035872E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberMD035872E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: