Individual
RICKY MCDANIELS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4607 MACCORKLE AVE SW STE 300, SOUTH CHARLESTON, WV 25309-1364
(304) 768-3688
Mailing address
4607 MACCORKLE AVE SW STE 300, SOUTH CHARLESTON, WV 25309-1364
(304) 768-3688
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1112738
WV
Other
Enumeration date
05/19/2014
Last updated
05/19/2014
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