Provider Demographics
NPI:1033327549
Name:MCDANIEL, JAMES D (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:D
Last Name:MCDANIEL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 NORMANDY EST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-9744
Mailing Address - Country:US
Mailing Address - Phone:304-622-2289
Mailing Address - Fax:
Practice Address - Street 1:469 EMILY DR
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-5512
Practice Address - Country:US
Practice Address - Phone:304-423-5180
Practice Address - Fax:304-423-5185
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV307363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical