Healthcare Provider Details

I. General information

NPI: 1053478867
Provider Name (Legal Business Name): DANIEL N DAVIDOW, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 11/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9407 CUMBERLAND RD
NEW KENT VA
23124-2029
US

IV. Provider business mailing address

8001 FRANKLIN FARMS DR SUITE 127
RICHMOND VA
23229-5108
US

V. Phone/Fax

Practice location:
  • Phone: 804-866-2242
  • Fax: 804-966-5639
Mailing address:
  • Phone: 804-282-9133
  • Fax: 804-282-9135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101049601
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101029182
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number0101034211
License Number StateVA

VIII. Authorized Official

Name: DR. DANIEL NELSON DAVIDOW
Title or Position: PRESIDENT
Credential: M.D.
Phone: 804-966-2242