Provider Demographics
NPI:1518958107
Name:SEN, DANIELLE GOTTLIEB (MD MPH MS)
Entity type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:GOTTLIEB
Last Name:SEN
Suffix:
Gender:F
Credentials:MD MPH MS
Other - Prefix:DR
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:GOTTLIEB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:850 POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-4607
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:848 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-2816
Practice Address - Country:US
Practice Address - Phone:901-287-7337
Practice Address - Fax:901-287-4646
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA226033208600000X
MDD89072208G00000X
LA300440208G00000X
TN55447208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA226033OtherMASSACHUSETTS LICENSE
MAMG0597508AOtherMA CONTROLLED SUBSTANCE
MA226033OtherMASSACHUSETTS LICENSE