Provider Demographics
NPI:1164076584
Name:LOCKHART, DARRON R (MBA)
Entity Type:Individual
Prefix:MR
First Name:DARRON
Middle Name:R
Last Name:LOCKHART
Suffix:
Gender:M
Credentials:MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6006 TOPPING LN
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-2419
Mailing Address - Country:US
Mailing Address - Phone:757-822-9368
Mailing Address - Fax:
Practice Address - Street 1:6006 TOPPING LN
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-2419
Practice Address - Country:US
Practice Address - Phone:757-822-9368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAT67142096172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver