Individual
DR. DANIEL I. MCNICHOL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
300 MAIN ST., UPSTATE ENT, VESTIL, NY 13850
(607) 786-9522
Mailing address
238 HUSSON AVE APT 2L, BANGOR, ME 04401-3258
(207) 945-6545
Taxonomy
Speciality
Code
Description
License number
State
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
Primary
146662
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010549490
FEDERAL ID TAX NO.
—
01
—
010823
ME LICENCE
ME
01
—
102902698
PASSPORT NO.
—
05
—
135670000
—
ME
01
—
146662
NY LICENCE
NY
01
—
1534155
DIVERS LICENCE ME
ME
Enumeration date
06/28/2006
Last updated
03/07/2023
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