MEDICARE: DR. ANDREW WALTER DANYLUK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	79169	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003816695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW WALTER DANYLUK MD

Provider Business Mailing Address
First Line	:	115 SOUTH ST
Second Line	:
City	:	WILLIAMSTOWN
State	:	MA
Zip	:	01267-2877
Country	:	US
Telephone Number	:	413-441-5874
Fax Number	:	413-895-0233

Provider Business Practice Location Address
First Line	:	115 SOUTH ST
Second Line	:
City	:	WILLIAMSTOWN
State	:	MA
Zip	:	01267-2877
Country	:	US
Telephone Number	:	413-441-5874
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	01/17/2023

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