MEDICARE: DR. DANIEL H TRACHTENBERG D.O.

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	2085R0202X	Diagnostic Radiology Physician	OS1762	FL
2	2085R0202X	Diagnostic Radiology Physician	OS002394L	PA

General Provider Information

NPI Number	:	1770864795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL H TRACHTENBERG D.O.

Provider Business Mailing Address
First Line	:	3546 S OCEAN BLVD
Second Line	:	#901
City	:	PALM BEACH
State	:	FL
Zip	:	33480-5739
Country	:	US
Telephone Number	:	561-588-0315
Fax Number	:

Provider Business Practice Location Address
First Line	:	3546 S OCEAN BLVD
Second Line	:	#901
City	:	PALM BEACH
State	:	FL
Zip	:	33480-5739
Country	:	US
Telephone Number	:	561-588-0315
Fax Number	:

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

Provider Enumeration Date	:	09/03/2011
Last Update Date	:	09/03/2011

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