Healthcare Provider Details

I. General information

NPI: 1760457055
Provider Name (Legal Business Name): DANIEL W KARAKLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 10/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GRESHAM DR SUITE 1100
NORFOLK VA
23507-1904
US

IV. Provider business mailing address

PO BOX 936
NORFOLK VA
23501-0936
US

V. Phone/Fax

Practice location:
  • Phone: 757-388-6200
  • Fax: 757-388-6201
Mailing address:
  • Phone: 757-388-6200
  • Fax: 757-388-6201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number0101222124
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: