Provider Demographics
NPI:1063595429
Name:MCDANIEL, DAVID H (MD, FAAD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:H
Last Name:MCDANIEL
Suffix:
Gender:M
Credentials:MD, FAAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6794
Mailing Address - Country:US
Mailing Address - Phone:757-437-8900
Mailing Address - Fax:757-437-8200
Practice Address - Street 1:125 MARKET ST
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6794
Practice Address - Country:US
Practice Address - Phone:757-437-8900
Practice Address - Fax:757-437-8200
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-21
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101035339174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA320852OtherBLUECROSS PIN #
VA070000267Medicare ID - Type UnspecifiedMEDICARE ID#
VA320852OtherBLUECROSS PIN #