Provider Demographics
NPI:1942545470
Name:NESSELROADE, DANIEL WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:WAYNE
Last Name:NESSELROADE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1821 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45505-1225
Mailing Address - Country:US
Mailing Address - Phone:937-323-7340
Mailing Address - Fax:937-323-3363
Practice Address - Street 1:1821 E HIGH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45505-1225
Practice Address - Country:US
Practice Address - Phone:937-323-7340
Practice Address - Fax:937-323-3363
Is Sole Proprietor?:No
Enumeration Date:2012-12-10
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35072374207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology