MEDICARE: MR. DANIEL WADE MCCLAIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376J00000X	Homemaker

General Provider Information

NPI Number	:	1497512636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL WADE MCCLAIN

Provider Business Mailing Address
First Line	:	1505 SHROYER RD APT 2
Second Line	:
City	:	OAKWOOD
State	:	OH
Zip	:	45419-3261
Country	:	US
Telephone Number	:	757-775-3737
Fax Number	:

Provider Business Practice Location Address
First Line	:	1505 SHROYER RD APT 2
Second Line	:
City	:	OAKWOOD
State	:	OH
Zip	:	45419-3261
Country	:	US
Telephone Number	:	757-775-3737
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2024
Last Update Date	:	03/04/2024

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