Provider Demographics
NPI:1134151814
Name:GOLWYN, DANIEL HOWARD JR (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:HOWARD
Last Name:GOLWYN
Suffix:JR
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:WAKE FOREST SCHOOL OF MEDICINE
Mailing Address - Street 2:MEDICAL CENTER BLVD.
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-1088
Mailing Address - Country:US
Mailing Address - Phone:336-716-2255
Mailing Address - Fax:
Practice Address - Street 1:WAKE FOREST SCHOOL OF MEDICINE
Practice Address - Street 2:MEDICAL CENTER BLVD.
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-1088
Practice Address - Country:US
Practice Address - Phone:336-716-2255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC95003562085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8936157Medicaid
NC2220846KMedicare PIN
NC2220846BMedicare PIN
NC2220846MMedicare PIN
NC2220864NMedicare PIN
G23207Medicare UPIN
NC2220846JMedicare PIN
NC8936157Medicaid