Provider Demographics
NPI:1174571848
Name:JALLER, DANIEL ANDREW (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ANDREW
Last Name:JALLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19500 AMARANTH DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-1209
Mailing Address - Country:US
Mailing Address - Phone:301-528-7111
Mailing Address - Fax:
Practice Address - Street 1:19500 AMARANTH DR
Practice Address - Street 2:SUITE A
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-1209
Practice Address - Country:US
Practice Address - Phone:301-528-7111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0033138207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP16991OtherCAREFIRST POS
MD521186611OtherUNITED HEALTHCARE PROV #
MD8140384OtherMAMSI PROVIDER NUMBER
MD42444606OtherBSMD
MD8140384OtherALLIANCE PROVIDER NUMBER
MD8140384OtherMDIPA PROVIDER NUMBER
MD8140384OtherOPTIMUM CHOICE PROVIDER #
MD499694OtherNCCPO
MD1327648OtherCIGNA PROVIDER NUMBER
MD9070 0028OtherBSDC
MD8140384OtherOPTIMUM CHOICE PROVIDER #
B95105Medicare UPIN