Provider Demographics
NPI:1053366914
Name:MCDANALD, DARRICK MATTHEW (MD)
Entity type:Individual
Prefix:MR
First Name:DARRICK
Middle Name:MATTHEW
Last Name:MCDANALD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2700 STANLEY GAULT PKWY
Mailing Address - Street 2:SUITE 129
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5132
Mailing Address - Country:US
Mailing Address - Phone:502-253-4917
Mailing Address - Fax:502-489-5751
Practice Address - Street 1:1023 NEW MOODY LN
Practice Address - Street 2:SUITE 103
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-9177
Practice Address - Country:US
Practice Address - Phone:502-222-5558
Practice Address - Fax:502-222-3040
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2020-12-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY34959174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64057730Medicaid
KY64057730Medicaid
KY0705404Medicare PIN