Basic Information
| Provider Information | |||||||||
| NPI: | 1952337115 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EARDLEY | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | P | ||||||||
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| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1030 PRESIDENT AVE | ||||||||
| Address2: | SUITE 3002 | ||||||||
| City: | FALL RIVER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027205923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086763411 | ||||||||
| FaxNumber: | 5086760932 | ||||||||
| Practice Location | |||||||||
| Address1: | 1030 PRESIDENT AVE | ||||||||
| Address2: | SUITE 3002 | ||||||||
| City: | FALL RIVER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027205923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086763411 | ||||||||
| FaxNumber: | 5086760932 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2006 | ||||||||
| LastUpdateDate: | 04/26/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MA73242 | MA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 000368 | 01 | SWH | OTHER | 020013713 | 01 | RAILROAD MED | OTHER | 073242 | 01 | TUFTS | OTHER | 3427308 | 01 | AETNA | OTHER | B20915902 | 01 | CIGNA | OTHER | 3066720 | 05 | MA | MEDICAID | J09838 | 01 | MA | BLUE CROSS BLUE SHIELD | OTHER | 5769116 002 | 01 | CIGNA FOR REFERRALS | OTHER | 17 01019 | 01 | UHC | OTHER | 201860 | 01 | BLUE CHIP | OTHER | DE07815 | 05 | RI | MEDICAID | 8406 | 01 | HPHC | OTHER | 000000021259 | 01 | BMC | OTHER | 0027844 | 01 | NHP | OTHER | 007057138 | 01 | MA | RAILROAD MEDICARE | OTHER | J09838 | 01 | MASS BS | OTHER |