Provider Demographics
NPI:1669569091
Name:MCKERNAN, DANIEL JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JOHN
Last Name:MCKERNAN
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 1:735 S SHOOP AVE
Mailing Address - Street 2:
Mailing Address - City:WAUSEON
Mailing Address - State:OH
Mailing Address - Zip Code:43567-1735
Mailing Address - Country:US
Mailing Address - Phone:419-335-2663
Mailing Address - Fax:419-335-9615
Practice Address - Street 1:735 S SHOOP AVE
Practice Address - Street 2:
Practice Address - City:WAUSEON
Practice Address - State:OH
Practice Address - Zip Code:43567-1735
Practice Address - Country:US
Practice Address - Phone:419-335-2663
Practice Address - Fax:419-335-9615
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH68947207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH200044061OtherRAILROAD MEDICARE
HI0826271Medicaid
OHP00685936OtherMEDICARE RAILROAD
OH0826271Medicaid
OH200044062OtherRAILROAD MEDICARE
OH4651433OtherAETNA
OH000000231279OtherANTHEM
OH000000231294OtherANTHEM
OH000000566680OtherANTHEM
OH02080OtherPARAMOUNT HEALTH INSURANC
OH000000231279OtherANTHEM
HI0826271Medicaid
OH000000566680OtherANTHEM
OHE93044Medicare UPIN
OH0791676Medicare PIN