Provider Demographics
NPI:1639123045
Name:DANIELS, HENRY MYRICK I (MD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:MYRICK
Last Name:DANIELS
Suffix:I
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 1:5866 LEESBURG PIKE
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22041-2309
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:82 PUUHONU PL
Practice Address - Street 2:SUITE# 205
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2010
Practice Address - Country:US
Practice Address - Phone:808-933-2400
Practice Address - Fax:808-933-2442
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-4154174400000X
VA0101039512207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI256365-03Medicaid
A 47540Medicare UPIN
HI101025Medicare ID - Type UnspecifiedHILO MED CNTR PROVIDER #