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General NPI Number Information
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NPI Number | 1073517819
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Entity Type | Individual
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Provider Name | CHARLES E DANIELSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/09/2005
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Last Update Date | 01/23/2012
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Provider Practice Location Address
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Address Line | 159 SILVER ST
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City | WATERVILLE
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State | ME
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Zip | 04901-5813
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Country | US
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Telephone | 207-873-5437
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Fax | 207-861-5448
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Provider Business Mailing Address
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Address Line | 159 SILVER ST
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City | WATERVILLE
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State | ME
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Zip | 04901-5813
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Country | US
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Telephone | 207-873-5437
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Fax | 207-861-5448
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 009473
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | 009473
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License Number State | ME
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