Healthcare Provider Details

I. General information

NPI: 1497836969
Provider Name (Legal Business Name): DANIEL HOCHBERGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PAWTUCKET AVE
RUMFORD RI
02916-2135
US

IV. Provider business mailing address

400 PAWTUCKET AVE
RUMFORD RI
02916-2135
US

V. Phone/Fax

Practice location:
  • Phone: 401-431-6224
  • Fax: 401-431-9011
Mailing address:
  • Phone: 401-431-6224
  • Fax: 401-431-9011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number066373
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: