Individual
DANIEL JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
400 FOXCROFT AVE STE 104, MARTINSBURG, WV 25401-5302
(304) 513-3495
Mailing address
1005 WHITE WILLOW WAY, MORGANTOWN, WV 26505-6119
(304) 513-3495
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
35058
WV
2084P0800X
Psychiatry Physician
MD045239
DC
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
06/05/2013
Last updated
04/15/2026
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