MEDICARE: DR. DANIEL B. REARDON M.D.

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	208600000X	Surgery Physician	RI4817	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	003670	OTHER	RI	BLUE CHIP PROVIDER ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	29143-3	OTHER	RI	BLUE CROSS PROVIDER ID

General Provider Information

NPI Number	:	1265431357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL B. REARDON M.D.

Provider Business Mailing Address
First Line	:	390 TOLL GATE RD
Second Line	:	STE.200
City	:	WARWICK
State	:	RI
Zip	:	02886-4326
Country	:	US
Telephone Number	:	401-691-3300
Fax Number	:	401-739-6087

Provider Business Practice Location Address
First Line	:	390 TOLL GATE RD
Second Line	:	STE.200
City	:	WARWICK
State	:	RI
Zip	:	02886-4326
Country	:	US
Telephone Number	:	401-691-3300
Fax Number	:	401-739-6087

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

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	07/08/2007

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Directions to “ DR. DANIEL B. REARDON M.D.” Practice Location

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