Provider Demographics
NPI:1982448460
Name:MCDANIEL, MARCUS LANE
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:LANE
Last Name:MCDANIEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 TRI COUNTY PKWY STE 201
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-3238
Mailing Address - Country:US
Mailing Address - Phone:513-290-5862
Mailing Address - Fax:
Practice Address - Street 1:155 TRI COUNTY PKWY STE 201
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-3238
Practice Address - Country:US
Practice Address - Phone:513-290-5862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-20
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No171M00000XOther Service ProvidersCase Manager/Care Coordinator