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General NPI Number Information
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NPI Number | 1275283939
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Entity Type | Individual
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Provider Name | DANNY BASEL GHANNOUM DPM
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Gender | Male
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Dates
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Enumeration Date | 03/25/2022
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Last Update Date | 01/22/2025
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Provider Practice Location Address
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Address Line | 222 WALNUT AVE SW
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City | ROANOKE
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State | VA
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Zip | 24016-4723
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Country | US
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Telephone | 540-344-3668
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Fax | 540-774-4615
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Provider Business Mailing Address
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Address Line | PO BOX 825159
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City | PHILADELPHIA
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State | PA
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Zip | 19182-5159
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Country | US
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Telephone | 866-626-1540
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Fax | 866-386-8526
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | PENDING
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License Number State | MA
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