Provider Demographics
NPI:1033182308
Name:BRIDDELL, DAN WARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:WARD
Last Name:BRIDDELL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 HAVERSHAM CLOSE
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454
Mailing Address - Country:US
Mailing Address - Phone:757-962-1920
Mailing Address - Fax:757-772-0554
Practice Address - Street 1:2300 HAVERSHAM CLOSE
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454
Practice Address - Country:US
Practice Address - Phone:757-962-1920
Practice Address - Fax:757-772-0554
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810000793103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
099310OtherANTHEM PPO
099310OtherANTHEM HEALTH KEEPERS
P00129394OtherMCARE RAILROAD
087087OtherSENTARA OPTIMA
254517OtherMAGELLAN
000014OtherVALUE OPTIONS
133055OtherMANAGED HEALTH NETWORK
254517OtherMAGELLAN
VA680000323Medicare ID - Type Unspecified