Basic Information
| Provider Information | |||||||||
| NPI: | 1184622482 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIDOW | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | NELSON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 202 WESTHAM PKWY | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232297431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8049662242 | ||||||||
| FaxNumber: | 8049665639 | ||||||||
| Practice Location | |||||||||
| Address1: | 9407 CUMBERLAND RD | ||||||||
| Address2: | |||||||||
| City: | NEW KENT | ||||||||
| State: | VA | ||||||||
| PostalCode: | 231242029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8049662242 | ||||||||
| FaxNumber: | 8049665639 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2005 | ||||||||
| LastUpdateDate: | 10/26/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080A0000X | VA0101034211 | VA | Y | Allopathic & Osteopathic Physicians | Pediatrics | Adolescent Medicine |
No ID Information.