MEDICARE: DR. SAMUEL DANIEL 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	207RG0100X	Gastroenterology Physician	138448	NY

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	:	1083622716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL DANIEL MD

Provider Business Mailing Address
First Line	:	PO BOX 95000-4145
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19195-0001
Country	:	US
Telephone Number	:	212-690-0303
Fax Number	:

Provider Business Practice Location Address
First Line	:	2771 FREDERICK DOUGLASS BLVD
Second Line	:	GROUND FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10039-3027
Country	:	US
Telephone Number	:	212-690-0303
Fax Number	:

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	10/18/2023

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