MEDICARE: DANIEL JACKSON DICKINSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	0101048745	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780679936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL JACKSON DICKINSON MD

Provider Business Mailing Address
First Line	:	5320 PROVIDENCE RD STE 301
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-4122
Country	:	US
Telephone Number	:	757-413-7600
Fax Number	:

Provider Business Practice Location Address
First Line	:	5320 PROVIDENCE RD STE 301
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-4122
Country	:	US
Telephone Number	:	757-413-7600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	07/05/2024

Similar Medicare Providers

1396723631 — AIMEE BUNDICK MORGAN PA
Practice Location Address:

5320 PROVIDENCE RD STE 301
VIRGINIA BEACH, VA
23464-4122

Practice Phone: 757-413-7600
Practice Fax: 757-413-7601

1235104555 — DR. NORMAN MANAOIS GONZALES MD
Practice Location Address:

5320 PROVIDENCE RD STE 301
VIRGINIA BEACH, VA
23464-4122

Practice Phone: 757-413-7600
Practice Fax: 757-413-7601

1992771521 — RAVINDER MOHAN MD
Practice Location Address:

5320 PROVIDENCE RD , SUITE 301
VIRGINIA BEACH, VA
23464-4122

Practice Phone: 757-413-7600
Practice Fax: 757-507-9051

1144283516 — DENNIS L. HUFFORD MD
Practice Location Address:

5320 PROVIDENCE RD , SUITE 301
VIRGINIA BEACH, VA
23464-4122

Practice Phone: 757-413-7600
Practice Fax: 757-507-9051

1497791669 — MS. TRACEY O PENNINGTON M.D.,M.P.H.
Practice Location Address:

5320 PROVIDENCE RD , SUITE 204
VIRGINIA BEACH, VA
23464-4122

Practice Phone: 757-962-2121
Practice Fax: 757-962-1911

1154339158 — DR. FRANCIS VALERIAN JAVIER M.D.
Practice Location Address:

5320 PROVIDENCE RD STE 301
VIRGINIA BEACH, VA
23464-4122

Practice Phone: 757-413-7600
Practice Fax: 757-507-9067

Directions to “ DANIEL JACKSON DICKINSON MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.