Provider Demographics
NPI:1518924950
Name:JANNUZZI, DANIEL M (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:M
Last Name:JANNUZZI
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 1:6530 HULL STREET RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23224-2636
Mailing Address - Country:US
Mailing Address - Phone:804-674-3425
Mailing Address - Fax:804-554-5388
Practice Address - Street 1:6530 HULL STREET RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23224-2636
Practice Address - Country:US
Practice Address - Phone:804-674-3425
Practice Address - Fax:804-554-5388
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101043345207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010046343Medicaid
VA010046343Medicaid
VA001775P39Medicare ID - Type Unspecified