Provider Demographics
NPI:1427034529
Name:RADER, DANNY (MD)
Entity type:Individual
Prefix:DR
First Name:DANNY
Middle Name:
Last Name:RADER
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:PO BOX 1137
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32902-1137
Mailing Address - Country:US
Mailing Address - Phone:321-952-9696
Mailing Address - Fax:321-794-0967
Practice Address - Street 1:2120 SARNO RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-3084
Practice Address - Country:US
Practice Address - Phone:321-241-6800
Practice Address - Fax:321-241-6890
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV14752207Q00000X, 207QA0401X
FLME139673207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0051779000Medicaid
WV1042844OtherWV DWC
WV000651768OtherBLUE CROSS BLUE SHIELD
WV930122358Medicare PIN
WV0622664Medicare PIN
WV0622666Medicare PIN
WV1042844OtherWV DWC
WV000651768OtherBLUE CROSS BLUE SHIELD
WV930122360Medicare PIN
WV930122359Medicare PIN