Healthcare Provider Details

I. General information

NPI: 1467433607
Provider Name (Legal Business Name): EMMETH DANIEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 06/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9501 FARRELL RD
FORT BELVOIR VA
22060-5901
US

IV. Provider business mailing address

8893 MCNAIR DR
ALEXANDRIA VA
22309-3956
US

V. Phone/Fax

Practice location:
  • Phone: 703-805-0414
  • Fax:
Mailing address:
  • Phone: 703-799-4938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101029244
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: