Healthcare Provider Details

I. General information

NPI: 1154947679
Provider Name (Legal Business Name): DANIEL W CLINE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2020
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3458 NEELY RD
JOINT BASE MDL NJ
08641-5312
US

IV. Provider business mailing address

3458 NEELY RD
JOINT BASE MDL NJ
08641-5312
US

V. Phone/Fax

Practice location:
  • Phone: 866-377-2778
  • Fax: 609-754-9558
Mailing address:
  • Phone: 866-377-2778
  • Fax: 609-754-9558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0102207024
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: