Basic Information
Provider Information | |||||||||
NPI: | 1760621114 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MCLAUGHLIN | ||||||||
FirstName: | DANIEL | ||||||||
MiddleName: | W | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 175 PLEASANT MEADOW ESTATES DR | ||||||||
Address2: |   | ||||||||
City: | MARION | ||||||||
State: | NC | ||||||||
PostalCode: | 287526583 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8286595700 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1615 OAKWOOD ST STE D | ||||||||
Address2: |   | ||||||||
City: | BEDFORD | ||||||||
State: | VA | ||||||||
PostalCode: | 245231250 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5405863089 | ||||||||
FaxNumber: | 5405865724 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/09/2009 | ||||||||
LastUpdateDate: | 06/29/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 06/29/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 201100667 | NC | N |   | Allopathic & Osteopathic Physicians | Surgery |   | 390200000X | ME101034 | FL | N |   | Student, Health Care | Student in an Organized Health Care Education/Training Program |   | 208600000X | 0101269444 | VA | Y |   | Allopathic & Osteopathic Physicians | Surgery |   |
No ID Information.