Provider Demographics
NPI:1295094431
Name:DANIELS, ELDRA W (MD)
Entity type:Individual
Prefix:
First Name:ELDRA
Middle Name:W
Last Name:DANIELS
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:PO BOX 858
Mailing Address - Street 2:MCA410
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-0858
Mailing Address - Country:US
Mailing Address - Phone:800-243-1455
Mailing Address - Fax:
Practice Address - Street 1:201 LEFEVER RD
Practice Address - Street 2:
Practice Address - City:MOUNT JOY
Practice Address - State:PA
Practice Address - Zip Code:17552-8803
Practice Address - Country:US
Practice Address - Phone:717-653-2910
Practice Address - Fax:717-653-2910
Is Sole Proprietor?:No
Enumeration Date:2012-05-09
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD467809207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine