=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952377996
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL A SUMMERS MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2006
-----------------------------------------------------
Last Update Date | 06/02/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 477 ANDOVER ST
-----------------------------------------------------
City | NORTH ANDOVER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01845-5036
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-975-3355
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 477 ANDOVER ST
-----------------------------------------------------
City | NORTH ANDOVER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01845-5036
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-975-3355
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 016871
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------