Provider Demographics
NPI:1154384089
Name:MULDOON, DANIEL (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:MULDOON
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 1:2216 PRINCESS ANNE ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3300
Mailing Address - Country:US
Mailing Address - Phone:540-840-9815
Mailing Address - Fax:540-371-3748
Practice Address - Street 1:2216 PRINCESS ANNE ST
Practice Address - Street 2:SUITE 106
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3300
Practice Address - Country:US
Practice Address - Phone:540-840-9815
Practice Address - Fax:540-371-3748
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057151207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine