Provider Demographics
NPI:1154618650
Name:DAN, MED (MD)
Entity type:Individual
Prefix:DR
First Name:MED
Middle Name:
Last Name:DAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MEDHANE
Other - Middle Name:HAGOS
Other - Last Name:MESGENA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:309 57TH ST
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:WV
Mailing Address - Zip Code:26105-2021
Mailing Address - Country:US
Mailing Address - Phone:207-766-6404
Mailing Address - Fax:
Practice Address - Street 1:108 OSPREY DR STE A
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:WV
Practice Address - Zip Code:26187-8556
Practice Address - Country:US
Practice Address - Phone:304-865-5101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-05
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD165962207Q00000X
WV30287207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine