Provider Demographics
NPI:1730164971
Name:FELTY, DANNY W (MD)
Entity type:Individual
Prefix:
First Name:DANNY
Middle Name:W
Last Name:FELTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7611 FOREST AVE STE 410
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-4946
Mailing Address - Country:US
Mailing Address - Phone:804-773-7611
Mailing Address - Fax:804-324-3434
Practice Address - Street 1:7611 FOREST AVE STE 410
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4946
Practice Address - Country:US
Practice Address - Phone:804-773-7611
Practice Address - Fax:804-324-3434
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101102681207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1730164971Medicaid
VAP00648486OtherRR MEDICARE
VA017042P77OtherMEDICARE PTAN
VAG96988Medicare UPIN
VA00V525V81Medicare ID - Type Unspecified
VA1730164971Medicaid