MEDICARE: DR. MED DAN 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	207Q00000X	Family Medicine Physician	77620	AZ
2	207Q00000X	Family Medicine Physician	30287	WV
3	207Q00000X	Family Medicine Physician	MD165962	OR

General Provider Information

NPI Number	:	1154618650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MED DAN MD

Provider Business Mailing Address
First Line	:	309 57TH ST
Second Line	:
City	:	VIENNA
State	:	WV
Zip	:	26105-2021
Country	:	US
Telephone Number	:	207-766-6404
Fax Number	:

Provider Business Practice Location Address
First Line	:	2720 S 6TH AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85713-4701
Country	:	US
Telephone Number	:	520-475-5418
Fax Number	:	520-300-8034

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

Provider Enumeration Date	:	07/05/2011
Last Update Date	:	02/10/2026

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