Healthcare Provider Details

I. General information

NPI: 1952517997
Provider Name (Legal Business Name): DANIEL J NOONAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 04/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3915 OLD LEE HWY UNIT 21C
FAIRFAX VA
22030-2432
US

IV. Provider business mailing address

8642 RESECA LN
SPRINGFIELD VA
22152-1411
US

V. Phone/Fax

Practice location:
  • Phone: 703-691-4000
  • Fax: 703-249-5186
Mailing address:
  • Phone: 703-249-9079
  • Fax: 703-249-5186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number0101032425
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: