Healthcare Provider Details

I. General information

NPI: 1134462690
Provider Name (Legal Business Name): LYDIA M MCDANIEL R.R.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2013
Last Update Date: 04/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MED CENTER DR
CLARKSBURG WV
26301-4155
US

IV. Provider business mailing address

1 MED CENTER DR
CLARKSBURG WV
26301-4155
US

V. Phone/Fax

Practice location:
  • Phone: 304-623-3461
  • Fax: 304-623-7633
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: