DR. DANIEL EVAN VIDERS (NPI# 1558354407) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558354407 |
| Entity Type | Individual |
| Full Name | DR. DANIEL EVAN VIDERS |
| Credential | MD |
| Practice Address |
3 Wake Robin Rd Unit 5 Lincoln RI 02865 |
| Mailing Address |
3 Wake Robin Rd Unit 5 Lincoln RI 02865-4208 |
| Practice Telephone | 4014759140 |
| Practice Fax Number | 4014752808 |
| Mailing Telephone | 4014759140 |
| Mailing Fax Number | 4014752808 |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2019-04-03 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | 11477 | RI | Allopathic & Osteopathic Physicians |
| N | 207N00000X | Dermatology | 042219 | CT | Allopathic & Osteopathic Physicians |
| N | 207N00000X | Dermatology | 75666 | MA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MA | BMC HEALTH NET | 000000028685 | 01 |
| CT | BLUE CARE FAMILY | 00142219600 | 01 |
| MA | TUFTS MASS | 075666 | 01 |
| CT | HEALTH NET | 2V2311 | 01 |
| MA | HEALTH OF NEW ENGLAND | 17462 | 01 |
| MA | US HEALTH CARE | 620067 | 01 |
| CT | OXFORD HEALTH PLANS | P1705911 | 01 |
| MA | NETWORK HEALTH | 997001 | 01 |
| MA | HARVARD PILGRIM | 4294 | 01 |
| MA | COMMERCIAL | 043158835 | 01 |
| MA | 3092917 | 05 | |
| CT | CONNECTICARE | 758835 | 01 |
| MA | BC BS OF MASS | J12248 | 01 |
| CT | TITLE 19 INS | 001422196 | 01 |
| CT | ANTHEM BC BS | 010042219CT02 | 01 |
| MA | ANTHEM BC BS | 010075666M02 | 01 |
| MA | UNITED HEALTH PLANS | 0303009 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 207 Southbridge St, Auburn, MA 015012548 | 5088327118 | 5088324758 |
| Street Address |
3 WAKE ROBIN RD UNIT 5 |
| City | LINCOLN |
| State | RI |
| Zip Code | 02865 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649705500 | Stephanie L Marlin | Physician Assistant | 3 Wake Robin Rd Unit 5, Lincoln, RI 02865-4208 | 2017-04-27 |
| 1053413484 | Nicholas Paul Bruno | Dermatology | 3 Wake Robin Rd Unit 5, Lincoln, RI 02865-4208 | 2006-09-05 |
| 1437142213 | Shane C Morgan | Physician Assistant | 3 Wake Robin Rd Unit 5, Lincoln, RI 02865-4208 | 2005-08-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346749868 | Ckri Incorporated | In Home Supportive Care | 1525 Old Louisquissett Pike, C201, Lincoln, RI 02865 | 2018-02-10 |
| 1053824805 | Daniel Boulanger | Specialist/Technologist | 1762 Louisquisset Pike, Lincoln, RI 02865 | 2017-11-14 |
| 1013449677 | Daniel Gardner | Physical Therapist | 618 George Washington Hwy, Lincoln, RI 02865 | 2017-03-31 |
| 1801335138 | Lucille Ellen Plasse | Registered Nurse | 19 Old Great Road, Lincoln, RI 02865 | 2017-02-20 |
| 1558752014 | Northern Rhode Island Cognitive Behavioral Therapy Inc | Social Worker | 640 George Washington Hwy Ste 103, Lincoln, RI 02865 | 2015-02-05 |
| 1528313004 | Sandra Faria | Counselor | 1525 Old Louisquisset Pike Ste B104, Lincoln, RI 02865 | 2012-07-19 |
| 1982832671 | Deborah F Katcher-buckley | Nurse Practitioner | 2 Wake Robin Rd Unit 201, Lincoln, RI 02865 | 2009-07-01 |
| 1558541011 | Dawn Marie Maguire | Social Worker | 640 George Washington Hwy Ste, Bdg B, Ste 103, Lincoln, RI 02865 | 2007-11-13 |
| 1477675262 | Rhode Island Hospital | Internal Medicine | 701 George Washington Hwy Ste 100, Lincoln, RI 02865 | 2007-04-04 |
| 1083789218 | Thomas Patrick Hines | Pediatrics | 6 Blackstone Valley Place Suite 306b, Lincoln, RI 02865 | 2006-11-22 |
| Find all providers in zip 02865 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982235883 | Dermatology Associates of Lincoln, LLC | Dermatology | 6969 South Street, Lincoln, NE 68506 | 2020-01-29 |
| 1619144003 | Casey Bowen | Dermatology | 6969 South St, Lincoln, NE 68506-2835 | 2008-05-14 |
| 1356407613 | Troy E Rustad, Md, Pa | Dermatology | 3334 Woodsshire Parkway, Lincoln, NE 68502 | 2006-12-29 |
| 1598838757 | Ann E Lott | Dermatology | 6406 Chesterfield Ct, Lincoln, NE 68510-2361 | 2006-11-16 |
| 1598863706 | Geoffrey Charles Basler | Dermatology | 2455 Pine Lake Road Suite 110, Lincoln, NE 68512-3612 | 2006-09-20 |
| 1295785525 | Brian Jean Herbin | Dermatology | 2455 Pine Lake Rd Ste 110, Lincoln, NE 68512-3665 | 2006-05-10 |
| 1417946484 | Mark D Heibel | Dermatology | 7701 Preserve Ln, Lincoln, NE 68516-4473 | 2005-10-20 |
| 1326036112 | Rex F Largen | Dermatology | 5533 S 27th Street, Suite 103, Lincoln, NE 68512-1664 | 2005-10-06 |
| 1003815101 | Stuart Paul Westburg | Dermatology | 2756 O St, Lincoln, NE 68510-1341 | 2005-07-20 |
| 1881690261 | Sutton Skin and Eye Clinic PC | Dermatology | 7100 Stephanie Ln Ste 100, Lincoln, NE 68516-5332 | 2005-06-22 |
| Find all providers in LINCOLN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.