Healthcare Provider Details

I. General information

NPI: 1124026588
Provider Name (Legal Business Name): STEPHEN VAN DAVIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 DEER RUN RD
DANVILLE VA
24540-2866
US

IV. Provider business mailing address

200 DEER RUN RD
DANVILLE VA
24540-2866
US

V. Phone/Fax

Practice location:
  • Phone: 434-799-0090
  • Fax: 434-799-0098
Mailing address:
  • Phone: 434-799-0090
  • Fax: 434-799-0098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD-25962
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101038033
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: