Healthcare Provider Details

I. General information

NPI: 1942261359
Provider Name (Legal Business Name): DANIEL RADACK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2235 STAPLES MILL RD STE 104 AMERICAN ACCESS CARE OF RICHMOND
RICHMOND VA
23230-2942
US

IV. Provider business mailing address

3806 DUCKLING WALK
GLEN ALLEN VA
23060-5969
US

V. Phone/Fax

Practice location:
  • Phone: 804-355-9729
  • Fax:
Mailing address:
  • Phone: 757-373-8852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101229807
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number0101229807
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: