Provider Demographics
NPI:1831664325
Name:PRITCHARD, DANIEL P (PA-C)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:P
Last Name:PRITCHARD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3967 IDLEWILD DR
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-4005
Mailing Address - Country:US
Mailing Address - Phone:440-785-2319
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE # E19
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-444-0181
Practice Address - Fax:216-445-4552
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.005760RX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH50.005760RXOtherOHIO STATE MEDICAL BOARD
1156882OtherNCCPA