Healthcare Provider Details

I. General information

NPI: 1033327549
Provider Name (Legal Business Name): JAMES D MCDANIEL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

469 EMILY DR
CLARKSBURG WV
26301-5512
US

IV. Provider business mailing address

100 NORMANDY EST
BRIDGEPORT WV
26330-9744
US

V. Phone/Fax

Practice location:
  • Phone: 304-423-5180
  • Fax: 304-423-5185
Mailing address:
  • Phone: 304-622-2289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number307
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: