Healthcare Provider Details

I. General information

NPI: 1659719904
Provider Name (Legal Business Name): DANIEL BROCK HEWITT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2013
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 CHESTNUT ST SUITE 620
PHILADELPHIA PA
19107-4316
US

IV. Provider business mailing address

112 KENDALL RDG
BOERNE TX
78015-8361
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-6864
  • Fax: 215-955-2878
Mailing address:
  • Phone: 210-854-8464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number318545
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number318545
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: