Provider Demographics
NPI:1013988104
Name:WHITESIDES, DANIEL BAXTER (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:BAXTER
Last Name:WHITESIDES
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 1:1524 E MOREHEAD ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1606
Mailing Address - Country:US
Mailing Address - Phone:704-343-3400
Mailing Address - Fax:704-343-3428
Practice Address - Street 1:1524 E MOREHEAD ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1606
Practice Address - Country:US
Practice Address - Phone:704-343-3400
Practice Address - Fax:704-343-3428
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC29445OtherMEDICAL BOARD LICENSE
NC200001185006OtherPHYS PRIVILEGE LICENSE
NCAW9371597OtherDEA NUMBER
NCAW9371597OtherDEA NUMBER