Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 8614 | NH |
N | 207ND0101X | MOHS-Micrographic Surgeon | 8614 | NH |
N | 207NS0135X | Procedural Dermatology | 8614 | NH |
Y | 208D00000X | General Practice Physician | 8614 | NH |
NPI | 1235102922 |
---|---|
Provider Name | Daniel Wolfe Collison |
First Address | Hanover, NH 03755-2008 |
Second Address | Hanover, NH 03755-2008 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2006 |
Last Update Date | 14/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0002051 | (05) | VT |
008614 | TUFTS (01) | |
0106540Y0NH01 | ANTHEM PROVIDER # (01) | |
070011185 | RAILROAD MEDICARE (01) | |
07502 | MVP (01) | |
20234 | MATTHEW THORNTON HP (01) | |
3083123 | AETNA HMO PROVIDER ID (01) | |
4248210 | AETNA PROVIDER ID (01) | |
7323862 | CIGNA NATIONAL PROVIDER (01) | |
80002051 | (05) | NH |
E52148 | (02) | |
E52148 | HARVARD PILGRIM (01) | |
P378192 | OXFORD (01) |