1134238371 NPI number — DANIEL M MCNABB MD

Table of content: DANIEL M MCNABB MD (NPI 1134238371)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134238371 NPI number — DANIEL M MCNABB MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCNABB
Provider First Name:
DANIEL
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134238371
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
805 N 2ND ST
Provider Second Line Business Mailing Address:
APT 4
Provider Business Mailing Address City Name:
MEDFORD
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54451-1119
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-510-7227
Provider Business Mailing Address Fax Number:
843-497-6601

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CAROLINA HEALTH SPECIALISTS 4615 OLEANDER DR
Provider Second Line Business Practice Location Address:
SUITE 201-A
Provider Business Practice Location Address City Name:
MYRTLE BEACH
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29577-1622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-449-9559
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  47312 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 34587800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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