MEDICARE: DR. DAVID DWYER 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	2085R0204X	Vascular & Interventional Radiology Physician	0101268011	VA
2	2085R0204X	Vascular & Interventional Radiology Physician	MD481174	PA
3	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1861928517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID DWYER MD

Provider Business Mailing Address
First Line	:	661 EVERGREEN AVE
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22902-4303
Country	:	US
Telephone Number	:	804-239-9434
Fax Number	:

Provider Business Practice Location Address
First Line	:	2235 STAPLES MILL RD STE 104
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23230-2942
Country	:	US
Telephone Number	:	804-355-9729
Fax Number	:	804-355-9731

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

Provider Enumeration Date	:	05/01/2017
Last Update Date	:	02/06/2026

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