Healthcare Provider Details

I. General information

NPI: 1184622482
Provider Name (Legal Business Name): DANIEL NELSON DAVIDOW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 10/26/2009
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

202 WESTHAM PKWY
RICHMOND VA
23229-7431
US

V. Phone/Fax

Practice location:
  • Phone: 804-966-2242
  • Fax: 804-966-5639
Mailing address:
  • Phone: 804-966-2242
  • Fax: 804-966-5639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberVA0101034211
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: