Provider Demographics
NPI:1558420737
Name:DANIELS, EDWIN (PAC)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:
Last Name:DANIELS
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27A WOODLANDS DR
Mailing Address - Street 2:
Mailing Address - City:WAYMART
Mailing Address - State:PA
Mailing Address - Zip Code:18472-9366
Mailing Address - Country:US
Mailing Address - Phone:570-488-9880
Mailing Address - Fax:570-488-9882
Practice Address - Street 1:27A WOODLANDS DR
Practice Address - Street 2:
Practice Address - City:WAYMART
Practice Address - State:PA
Practice Address - Zip Code:18472-9366
Practice Address - Country:US
Practice Address - Phone:570-488-9880
Practice Address - Fax:570-488-9882
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA000907L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PWS19533Medicare UPIN