Provider Demographics
NPI:1053687681
Name:DANVILLE VASCULAR ACCESS, LLC
Entity Type:Organization
Organization Name:DANVILLE VASCULAR ACCESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIKORSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-644-8900
Mailing Address - Street 1:1200 WEST SWEDESFORD ROAD
Mailing Address - Street 2:BLDG 3 SUITE 300
Mailing Address - City:BERWYN
Mailing Address - State:PA
Mailing Address - Zip Code:19312-1172
Mailing Address - Country:US
Mailing Address - Phone:610-644-8900
Mailing Address - Fax:610-644-8909
Practice Address - Street 1:800 MEMORIAL DR
Practice Address - Street 2:SUITE C
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-1679
Practice Address - Country:US
Practice Address - Phone:434-792-6826
Practice Address - Fax:434-792-6829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty