Organization
DANIEL E VIDERS MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANIEL EVAN VIDERS MD (OWNER)
(508) 832-7118
Entity
Organization
Contact information
Practice address
207 SOUTHBRIDGE ST, AUBURN, MA 01501-2548
(508) 832-7118
(508) 917-8706
Mailing address
207 SOUTHBRIDGE ST, AUBURN, MA 01501-2548
(508) 832-7118
(508) 832-7166
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
75666
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4294
HARVARD PILGRIM
MA
01
—
651104
TUFTS
MA
01
—
99700102
NETWORK HEALTH
MA
01
—
M19161
BC/BS OF MASS
MA
Enumeration date
05/22/2006
Last updated
05/05/2021
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