Provider Demographics
NPI:1043291743
Name:DANIELS, JAMES R JR (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:DANIELS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:RAY
Other - Last Name:DANIELS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:500 SENTARA CIR STE 202
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-5727
Mailing Address - Country:US
Mailing Address - Phone:757-984-9850
Mailing Address - Fax:
Practice Address - Street 1:500 SENTARA CIR STE 202
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-5727
Practice Address - Country:US
Practice Address - Phone:757-984-9850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCTL28385208600000X
VA0101232947208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7313179Medicaid
SCH69211Medicare UPIN
VA015310R64Medicare PIN
SCH692111290Medicare ID - Type Unspecified