Provider Demographics
NPI:1578553178
Name:RYDLAND, DANINE ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:DANINE
Middle Name:ANNE
Last Name:RYDLAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1952 ROCK CLIFF DR
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-2894
Mailing Address - Country:US
Mailing Address - Phone:304-596-2310
Mailing Address - Fax:304-596-2312
Practice Address - Street 1:1952 ROCK CLIFF DR
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-2894
Practice Address - Country:US
Practice Address - Phone:304-596-2310
Practice Address - Fax:304-596-2312
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV14040207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0094688000Medicaid
D49386Medicare UPIN
WV0094688000Medicaid