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NPI Code Detail

MEDICARE: DR. DANIEL A PEDERSEN DO

MEDICARE: DR. DANIEL A PEDERSEN DO
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
1390200000XStudent in an Organized Health Care Education/Training Program
2207Q00000XFamily Medicine PhysicianOS021569PA
3207Q00000XFamily Medicine Physician25MB09405100NJ

General Provider Information

NPI Number : 1790066108
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DANIEL A PEDERSEN DO
Provider Business Mailing Address
First Line : 1450E CHESTNUT AVE 3D
Second Line :
City : VINELAND
State : NJ
Zip : 08361-8469
Country : US
Telephone Number : 856-692-0050
Fax Number : 856-692-0081
Provider Business Practice Location Address
First Line : 200 SCHUYLKILL MEDICAL PLZ
Second Line :
City : POTTSVILLE
State : PA
Zip : 17901-3660
Country : US
Telephone Number : 570-621-9270
Fax Number : 570-621-9271
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2011
Last Update Date : 11/27/2023

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