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General NPI Number Information
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NPI Number | 1184716938
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Entity Type | Individual
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Provider Name | REZA J DAUGHERTY MD
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Gender | Male
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 11/24/2025
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Provider Practice Location Address
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Address Line | 1215 LEE ST
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22908-0816
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Country | US
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Telephone | 434-924-9400
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Fax | 434-982-1618
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Provider Business Mailing Address
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Address Line | PO BOX 749112
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City | ATLANTA
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State | GA
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Zip | 30374-9112
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Country | US
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Telephone | 434-295-1000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 0101264628
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207PP0204X
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Taxonomy Name | Pediatric Emergency Medicine (Emergency Medicine) Physician
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License Number | C10007905
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License Number State | DE
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | C10007905
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License Number State | DE
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Taxonomy #4
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Taxonomy Code | 2085P0229X
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Taxonomy Name | Pediatric Radiology Physician
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License Number | 0101264628
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License Number State | VA
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Taxonomy #5
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD419063
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License Number State | PA
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Taxonomy #6
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Taxonomy Code | 2080P0204X
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Taxonomy Name | Pediatric Emergency Medicine (Pediatrics) Physician
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License Number | C10007905
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License Number State | DE
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