Provider Demographics
NPI:1144249400
Name:ADDIS, DANIEL M (MD, DO)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:M
Last Name:ADDIS
Suffix:
Gender:M
Credentials:MD, DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 PARKER RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-4034
Mailing Address - Country:US
Mailing Address - Phone:434-791-7366
Mailing Address - Fax:434-791-3438
Practice Address - Street 1:219 PARKER RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-4034
Practice Address - Country:US
Practice Address - Phone:434-791-7366
Practice Address - Fax:434-791-3438
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102201320207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1248110001Medicare NSC
VA009885P78Medicare PIN