Healthcare Provider Details

I. General information

NPI: 1669518205
Provider Name (Legal Business Name): VICTOR OWUSU-YAW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 10/02/2022
Certification Date: 10/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 BROAD ST # B
DANVILLE VA
24541-2301
US

IV. Provider business mailing address

129 BROAD ST # B
DANVILLE VA
24541-2301
US

V. Phone/Fax

Practice location:
  • Phone: 434-791-2600
  • Fax: 434-792-5347
Mailing address:
  • Phone: 434-791-2600
  • Fax: 434-792-5347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number0101051774
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: