Provider Demographics
NPI:1821606393
Name:GAGE, DANIEL RICHARD
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:RICHARD
Last Name:GAGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:STRUTHERS
Mailing Address - State:OH
Mailing Address - Zip Code:44471-1136
Mailing Address - Country:US
Mailing Address - Phone:330-398-8634
Mailing Address - Fax:
Practice Address - Street 1:615 MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:STRUTHERS
Practice Address - State:OH
Practice Address - Zip Code:44471-1136
Practice Address - Country:US
Practice Address - Phone:330-398-8634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHUM367991OtherLICENSE NUMBER