Provider Demographics
NPI:1447272877
Name:MCCULLOUGH, DANIEL G (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:G
Last Name:MCCULLOUGH
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 1:1841 QUIET CV
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3985
Mailing Address - Country:US
Mailing Address - Phone:910-323-2626
Mailing Address - Fax:
Practice Address - Street 1:1841 QUIET CV
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3985
Practice Address - Country:US
Practice Address - Phone:910-323-2626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2023-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0008599208600000X
MDD0066111208600000X
VA0101239438208600000X
OH35.085882208600000X
NC2023-02057208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery