Provider Demographics
NPI:1356914576
Name:DANIELS, CHARLES LAMAR
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:LAMAR
Last Name:DANIELS
Suffix:
Gender:M
Credentials:
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 40153
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-0153
Mailing Address - Country:US
Mailing Address - Phone:513-704-1268
Mailing Address - Fax:
Practice Address - Street 1:7416 POLO SPRINGS CT
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-4780
Practice Address - Country:US
Practice Address - Phone:513-704-1268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-24
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator