Organization
MEDICAL ASSOCIATES OF GLEN DANIEL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSE JORGE GORDINHO MD (PRESIDENT)
(304) 254-9022
Entity
Organization
Contact information
Practice address
109 BOLT ROAD, GLEN DANIEL, WV 25844
(304) 934-5125
Mailing address
310 GEORGE ST, BECKLEY, WV 25801-2653
(304) 254-9022
(304) 254-9024
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
PENDING
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0072202000
—
WV
Enumeration date
07/19/2006
Last updated
08/29/2007
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