Provider Demographics
NPI:1770387722
Name:BAETZHOLD, DANIEL JAMES
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:JAMES
Last Name:BAETZHOLD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 AUBURN AVE LOWR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14222-1419
Mailing Address - Country:US
Mailing Address - Phone:716-574-1491
Mailing Address - Fax:
Practice Address - Street 1:955 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1121
Practice Address - Country:US
Practice Address - Phone:716-829-2802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty