MEDICARE: DR. DANIEL RADACK 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	2085R0202X	Diagnostic Radiology Physician	0101229807	VA
2	2085R0204X	Vascular & Interventional Radiology Physician	0101229807	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942261359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL RADACK M.D.

Provider Business Mailing Address
First Line	:	3806 DUCKLING WALK
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23060-5969
Country	:	US
Telephone Number	:	757-373-8852
Fax Number	:

Provider Business Practice Location Address
First Line	:	2235 STAPLES MILL RD STE 104
Second Line	:	AMERICAN ACCESS CARE OF RICHMOND
City	:	RICHMOND
State	:	VA
Zip	:	23230-2942
Country	:	US
Telephone Number	:	804-355-9729
Fax Number	:

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

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	01/23/2023

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