Organization
MEDICAL ASSOCIATES OF GLEN DANIELS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
J JORGE GORDINHO MD (OWNER)
(304) 934-5125
Entity
Organization
Contact information
Practice address
264 COAL RIVER RD, GLEN DANIEL, WV 25844-9402
(304) 934-5125
(304) 934-6967
Mailing address
PO BOX 216, GLEN DANIEL, WV 25844
(304) 934-5125
(304) 934-6967
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
16005
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810003365
—
WV
Enumeration date
02/28/2007
Last updated
06/05/2015
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