Provider Demographics
NPI:1902144512
Name:OLIVERO, DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:OLIVERO
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 1:1243 SKYTOP MOUNTAIN RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PORT MATILDA
Mailing Address - State:PA
Mailing Address - Zip Code:16870-7725
Mailing Address - Country:US
Mailing Address - Phone:814-499-3009
Mailing Address - Fax:814-470-4421
Practice Address - Street 1:1243 SKYTOP MOUNTAIN RD STE 4
Practice Address - Street 2:
Practice Address - City:PORT MATILDA
Practice Address - State:PA
Practice Address - Zip Code:16870-7725
Practice Address - Country:US
Practice Address - Phone:814-499-3009
Practice Address - Fax:814-470-4421
Is Sole Proprietor?:No
Enumeration Date:2013-01-17
Last Update Date:2024-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD455879207Q00000X, 207QA0401X, 208M00000X, 208000000X
AL46215207Q00000X
AK207870207Q00000X
LA333693207Q00000X
AZ67578207Q00000X
DCMD210011928207Q00000X
ARE-16741207Q00000X
CAC184112207Q00000X
COCDR.0002656207Q00000X
CT074004207Q00000X
DEC1-0026012207Q00000X
NC2023-003192084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103054821Medicaid