Provider Demographics
NPI:1942475678
Name:BATEMAN, DANIEL R (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:R
Last Name:BATEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3707 DOTY RD STE A
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-7530
Mailing Address - Country:US
Mailing Address - Phone:815-334-5018
Mailing Address - Fax:815-337-5499
Practice Address - Street 1:3707 DOTY RD STE A
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-7530
Practice Address - Country:US
Practice Address - Phone:815-334-5018
Practice Address - Fax:815-337-5499
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH390200000X2084P0800X
IN01075387A2084P0800X
VT04200117892084P0805X, 2084P0800X
IL0361620292084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201300990Medicaid
VT1016493Medicaid
NH14531OtherNEW HAMPSHIRE MEDICAL LICENSE
VT001132801OtherMEDICARE PIN LINKED TO CVMC
VT001132802OtherMEDICARE PIN LINKED TO CVMC MGP
NH14531OtherNEW HAMPSHIRE MEDICAL LICENSE