Provider Demographics
NPI:1578565776
Name:DANIEL, TERRY G (MD)
Entity Type:Individual
Prefix:
First Name:TERRY
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 1:250 W KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27288-5010
Mailing Address - Country:US
Mailing Address - Phone:336-623-5171
Mailing Address - Fax:336-627-5747
Practice Address - Street 1:250 W KINGS HWY
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288-5010
Practice Address - Country:US
Practice Address - Phone:336-623-5171
Practice Address - Fax:336-627-5747
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC38038207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8926935Medicaid
NC2157063AMedicare ID - Type UnspecifiedMEDICARE
NC8926935Medicaid