Provider Demographics
NPI:1710091046
Name:KNODEL, DANIEL HARLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:HARLEY
Last Name:KNODEL
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 1:13916 230TH STREET CT E
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98338-7622
Mailing Address - Country:US
Mailing Address - Phone:360-893-8660
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF THE ARMY
Practice Address - Street 2:MADIGAN ARMY MEDICAL CENTER
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-1100
Practice Address - Country:US
Practice Address - Phone:253-968-1892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00019234174400000X
UT3099330-1205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU19704Medicare UPIN