MEDICARE: DR. KENNETH S. DANIELSON 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	207R00000X	Internal Medicine Physician	0420006525	VT
2	208600000X	Surgery Physician	5957	NH

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720037252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH S. DANIELSON M.D.

Provider Business Mailing Address
First Line	:	1290 HOSPITAL DR
Second Line	:	SUITE 1
City	:	ST JOHNSBURY
State	:	VT
Zip	:	05819-9205
Country	:	US
Telephone Number	:	802-748-2984
Fax Number	:

Provider Business Practice Location Address
First Line	:	1290 HOSPITAL DR
Second Line	:
City	:	ST JOHNSBURY
State	:	VT
Zip	:	05819-9205
Country	:	US
Telephone Number	:	802-748-2984
Fax Number	:

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

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	03/06/2020

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Directions to “ DR. KENNETH S. DANIELSON M.D.” Practice Location

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