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General NPI Number Information
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NPI Number | 1215936067
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Entity Type | Individual
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Provider Name | DEAN G. GIANAKOS M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/14/2005
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Last Update Date | 06/30/2009
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Provider Practice Location Address
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Address Line | 2323 MEMORIAL AVE SUITE 10
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City | LYNCHBURG
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State | VA
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Zip | 24501-2661
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Country | US
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Telephone | 434-200-5200
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Fax |
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Provider Business Mailing Address
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Address Line | 1204 FENWICK DR
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City | LYNCHBURG
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State | VA
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Zip | 24502-2112
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Country | US
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Telephone |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0101039392
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License Number State | VA
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