MEDICARE: BRIAN DANIELS 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	2080S0010X	Pediatric Sports Medicine Physician	ME138351	FL
2	207QS0010X	Sports Medicine (Family Medicine) Physician	276592	NY
3	207Q00000X	Family Medicine Physician	35992	SC

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	:	1780909606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN DANIELS M.D.

Provider Business Mailing Address
First Line	:	310 TAUGHANNOCK BLVD
Second Line	:
City	:	ITHACA
State	:	NY
Zip	:	14850-3251
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	310 TAUGHANNOCK BLVD
Second Line	:
City	:	ITHACA
State	:	NY
Zip	:	14850-3251
Country	:	US
Telephone Number	:	607-252-3580
Fax Number	:

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

Provider Enumeration Date	:	04/03/2010
Last Update Date	:	06/07/2026

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