Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 14752 | WV |
N | 207QA0401X | Family Doctor - Addiction Medicine | 14752 | WV |
NPI | 1427034529 |
---|---|
Provider Name | Dr. Danny Rader |
First Address | Charleston, WV 25304-2952 |
Second Address | Charleston, WV 25304-1848 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2005 |
Last Update Date | 25/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A72606 | (02) | WV |