Provider Demographics
NPI:1144434762
Name:BROCKMAN, DANIEL SCOTT (DO)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:SCOTT
Last Name:BROCKMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 HEMLOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-3964
Mailing Address - Country:US
Mailing Address - Phone:716-574-1551
Mailing Address - Fax:
Practice Address - Street 1:462 GRIDER ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-3021
Practice Address - Country:US
Practice Address - Phone:716-574-1551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY249468207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101924377Medicaid
PA111167OtherGEISINGER
PA212476OtherUNISON-WMG
PA20067553OtherAMERIHEALTH MERCY-WMG
PA1566797OtherGATEWAY-WMG
PA1969203OtherHIGHMARK BLUE SHIELD
MD897588OtherCAREFIRST MD BCBS
PA210805OtherJOHNS HOPKINS
2161248OtherMAMSI-WMG
PA50069804OtherCAPITAL BLUE CROSS-WMG
PA9203104OtherAETNA
PA101924377Medicaid
PAP00447749Medicare PIN