Provider Demographics
NPI:1942290853
Name:DRISCOLL, DANIEL F (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:F
Last Name:DRISCOLL
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 1:1690 CROWN COLONY DR
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-0913
Mailing Address - Country:US
Mailing Address - Phone:857-403-4600
Mailing Address - Fax:
Practice Address - Street 1:475 ADAMS ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186
Practice Address - Country:US
Practice Address - Phone:617-698-1202
Practice Address - Fax:617-364-7363
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA53967207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3001521Medicaid
B97895Medicare UPIN
J04765Medicare PIN
MAJ04765Medicare ID - Type Unspecified
MAB97895Medicare UPIN