Provider Demographics
NPI:1689649832
Name:MCCREADY, DANIEL R (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:R
Last Name:MCCREADY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 ATLANTIC SHORES DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-7311
Mailing Address - Country:US
Mailing Address - Phone:757-721-1281
Mailing Address - Fax:757-721-2988
Practice Address - Street 1:1200 ATLANTIC SHORES DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-7311
Practice Address - Country:US
Practice Address - Phone:757-721-1281
Practice Address - Fax:757-721-2988
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101027450207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005621771Medicaid
B07842Medicare UPIN
VA005621771Medicaid