Provider Demographics
NPI:1396701264
Name:BEALS, DANIEL ALFRED (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:ALFRED
Last Name:BEALS
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 1:1448 10TH AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3579
Mailing Address - Country:US
Mailing Address - Phone:304-691-8722
Mailing Address - Fax:
Practice Address - Street 1:1600 MEDICAL CENTER DR STE 2500
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701
Practice Address - Country:US
Practice Address - Phone:304-691-1200
Practice Address - Fax:304-691-1287
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV155012086S0102X, 2086S0120X, 208600000X
KY359692086S0102X, 2086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64011539Medicaid
KY0000000539899OtherANTHEM
G02417Medicare UPIN