Provider Demographics
NPI:1043319296
Name:GUANZON, CESAR S (MD)
Entity Type:Individual
Prefix:DR
First Name:CESAR
Middle Name:S
Last Name:GUANZON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 GRAY ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-2942
Mailing Address - Country:US
Mailing Address - Phone:434-770-1430
Mailing Address - Fax:
Practice Address - Street 1:130 GRAY ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-2942
Practice Address - Country:US
Practice Address - Phone:434-770-1430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01014021802208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7354681Medicaid
VA214747OtherANTHEM BCBS
VA214747OtherANTHEM BCBS