Provider Demographics
NPI:1063845063
Name:DANIEL, DAVID G (MD,)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:G
Last Name:DANIEL
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7137
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22106-7137
Mailing Address - Country:US
Mailing Address - Phone:703-638-2500
Mailing Address - Fax:
Practice Address - Street 1:1071 CEDRUS LN
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-1105
Practice Address - Country:US
Practice Address - Phone:703-638-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010400142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry