Provider Demographics
NPI:1265519680
Name:MERENDA, DANIEL JAMES (MD)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:JAMES
Last Name:MERENDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:527 MEDICAL PARK DR STE 501
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-9010
Mailing Address - Country:US
Mailing Address - Phone:681-342-3570
Mailing Address - Fax:681-342-3575
Practice Address - Street 1:527 MEDICAL PARK DR STE 501
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-9010
Practice Address - Country:US
Practice Address - Phone:681-342-3570
Practice Address - Fax:681-342-3575
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV21984207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810005396Medicaid
WV3810005396Medicaid