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General NPI Number Information
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NPI Number | 1699755066
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Entity Type | Individual
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Provider Name | GEORG JONATHAN DAHL MD
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Gender | Male
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Dates
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Enumeration Date | 01/20/2006
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Last Update Date | 08/02/2023
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Provider Practice Location Address
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Address Line | 850 SOUTHAMPTON AVE FL 3
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City | NORFOLK
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State | VA
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Zip | 23510-1021
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Country | US
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Telephone | 757-668-9920
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Fax | 757-668-9930
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Provider Business Mailing Address
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Address Line | 850 SOUTHAMPTON AVE FL 3
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City | NORFOLK
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State | VA
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Zip | 23510-1021
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Country | US
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Telephone | 757-668-9920
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Fax | 757-668-9930
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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 | 2084N0402X
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Taxonomy Name | Neurology with Special Qualifications in Child Neurology Physician
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License Number | 0101236801
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License Number State | VA
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