Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 146662 | NY |
NPI | 1376570788 |
---|---|
Provider Name | Dr. Daniel I. Mcnichol |
First Address | Bangor, ME 04401-3258 |
Second Address | Vestil, NY 13850 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 10/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010549490 | FEDERAL ID TAX NO. (01) | |
010823 | ME LICENCE (01) | ME |
102902698 | PASSPORT NO. (01) | |
135670000 | (05) | ME |
146662 | NY LICENCE (01) | NY |
1534155 | DIVERS LICENCE ME (01) | ME |
B86520 | (02) | ME |
BM077907 | DEA (01) | ME |