NPIMap

Organization Active NPI

Medical Associates of Glen Daniels, PLLC

  • Family Medicine Physician
  • Glen Daniel, WV
National Provider Identifier
1730216557
Registry record updated Jun 5, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
16005 Issued in WV
Legal business name
MEDICAL ASSOCIATES OF GLEN DANIELS, PLLC
Practice address
264 Coal River Rd
Glen Daniel, WV 25844-9402
Phone
(304) 934-5125
Fax
(304) 934-6967
NPI assigned
Feb 28, 2007
Last updated
Jun 5, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
J Jorge Gordinho, MD
Title
Owner
Phone
(304) 934-5125

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 16005 WV Primary

Addresses

Primary practice location

264 Coal River Rd
Glen Daniel, WV 25844-9402

Mailing address

PO Box 216
Glen Daniel, WV 25844
Phone (304) 934-5125

Other identifiers 1

IdentifierTypeStateIssuer
3810003365MedicaidWV

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433462400000",
    "number": "1730216557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 216",
            "city": "GLEN DANIEL",
            "state": "WV",
            "postal_code": "25844",
            "telephone_number": "304-934-5125",
            "fax_number": "304-934-6967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "264 COAL RIVER RD",
            "city": "GLEN DANIEL",
            "state": "WV",
            "postal_code": "258449402",
            "telephone_number": "304-934-5125",
            "fax_number": "304-934-6967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL ASSOCIATES OF GLEN DANIELS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-28",
        "last_updated": "2015-06-05",
        "status": "A",
        "authorized_official_last_name": "GORDINHO",
        "authorized_official_first_name": "J",
        "authorized_official_middle_name": "JORGE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "304-934-5125",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WV",
            "license": "16005",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810003365",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Daniel, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.