MEDICARE: DR. DANIEL L DELLATORRE MD

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	207N00000X	Dermatology Physician	D23131	MD

General Provider Information

NPI Number	:	1891833398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL L DELLATORRE MD

Provider Business Mailing Address
First Line	:	5454 WISCONSIN AVENUE
Second Line	:	SUITE #855
City	:	CHEVY CHASE
State	:	MD
Zip	:	20815-6926
Country	:	US
Telephone Number	:	301-652-2585
Fax Number	:	301-652-0380

Provider Business Practice Location Address
First Line	:	5454 WISCONSIN AVENUE
Second Line	:	SUITE #855
City	:	CHEVY CHASE
State	:	MD
Zip	:	20815-6926
Country	:	US
Telephone Number	:	301-652-2585
Fax Number	:	301-652-0380

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

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	07/08/2007

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