Healthcare Provider Details

I. General information

NPI: 1730710864
Provider Name (Legal Business Name): DANIEL LEVY RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2020
Last Update Date: 01/28/2020
Certification Date: 01/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 CEDAR CMNS
CHESAPEAKE VA
23322-6001
US

IV. Provider business mailing address

501 CEDAR CMNS
CHESAPEAKE VA
23322-6001
US

V. Phone/Fax

Practice location:
  • Phone: 757-544-3413
  • Fax:
Mailing address:
  • Phone: 757-544-3413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License Number0117002347
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: