Provider Demographics
NPI:1346295698
Name:STICKLER, DANIEL L II (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:L
Last Name:STICKLER
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 KANAWHA BLVD E
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25311-2413
Mailing Address - Country:US
Mailing Address - Phone:304-347-4313
Mailing Address - Fax:304-347-4316
Practice Address - Street 1:1516 KANAWHA BLVD E
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25311-2413
Practice Address - Country:US
Practice Address - Phone:304-347-4313
Practice Address - Fax:304-347-4316
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2011-01840208D00000X
WV19806208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7300018000Medicaid
WV7300018000Medicaid