Provider Demographics
NPI:1073588901
Name:VIA, DAN F (MD)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:F
Last Name:VIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4374 NEW TOWN AVE
Mailing Address - Street 2:STE 202
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-2865
Mailing Address - Country:US
Mailing Address - Phone:757-253-5757
Mailing Address - Fax:757-510-9063
Practice Address - Street 1:4374 NEW TOWN AVE
Practice Address - Street 2:STE 202
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-2865
Practice Address - Country:US
Practice Address - Phone:757-253-5757
Practice Address - Fax:757-510-9063
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101055236208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010099811Medicaid
006235S33Medicare ID - Type Unspecified
VA010099811Medicaid