Provider Demographics
NPI:1174588180
Name:MORETTA, DANIEL NEIL (DO)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:NEIL
Last Name:MORETTA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3244 BAILEY ST NW
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-3616
Mailing Address - Country:US
Mailing Address - Phone:330-837-8391
Mailing Address - Fax:330-837-6782
Practice Address - Street 1:3244 BAILEY ST NW
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-3616
Practice Address - Country:US
Practice Address - Phone:330-837-8391
Practice Address - Fax:330-837-6782
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34003505207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0530956Medicaid
OHA15398Medicare UPIN
OH0530956Medicaid