MEDICARE: DR. DANIELLE MARIE FAM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	0101257442	VA
2	207R00000X	Internal Medicine Physician	C175478	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1932427622	OTHER	VA	NPI

General Provider Information

NPI Number	:	1932427622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIELLE MARIE FAM M.D.

Provider Business Mailing Address
First Line	:	3241 WESTERN BRANCH BLVD
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23321-5260
Country	:	US
Telephone Number	:	757-686-3508
Fax Number	:	757-686-0541

Provider Business Practice Location Address
First Line	:	1665 UNION ST STE A
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-2906
Country	:	US
Telephone Number	:	619-663-5344
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2010
Last Update Date	:	01/04/2022

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