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General NPI Number Information
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NPI Number | 1477037950
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Entity Type | Individual
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Provider Name | DANIEL GOSHORN PA-C
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Gender | Male
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Dates
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Enumeration Date | 09/20/2018
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Last Update Date | 09/20/2018
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Provider Practice Location Address
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Address Line | 1368 AMERICAN WAY
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City | BEDFORD
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State | VA
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Zip | 24523-2940
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Country | US
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Telephone | 540-587-8612
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Fax |
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Provider Business Mailing Address
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Address Line | 29 CHASE DR APT 103
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City | FOREST
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State | VA
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Zip | 24551-3109
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Country | US
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Telephone | 814-599-7407
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0110-006404
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License Number State | VA
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