Provider Demographics
NPI:1053384008
Name:O'DEA, DANIEL J (MD FACC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
Last Name:O'DEA
Suffix:
Gender:M
Credentials:MD FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 COLUMBIA ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-3923
Mailing Address - Country:US
Mailing Address - Phone:845-473-1188
Mailing Address - Fax:845-473-0896
Practice Address - Street 1:1 COLUMBIA ST
Practice Address - Street 2:SUITE 200
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-3923
Practice Address - Country:US
Practice Address - Phone:845-473-1188
Practice Address - Fax:845-473-0896
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY165831207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01120570Medicaid
NY32E851Medicare PIN
NYA62190Medicare UPIN