Provider Demographics
NPI:1215195854
Name:DANIELIDES, STAMATINA
Entity Type:Individual
Prefix:
First Name:STAMATINA
Middle Name:
Last Name:DANIELIDES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MATINA
Other - Middle Name:
Other - Last Name:DANIELIDES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 91734
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23291-1734
Mailing Address - Country:US
Mailing Address - Phone:804-358-6100
Mailing Address - Fax:804-342-7619
Practice Address - Street 1:1250 E MARSHALL ST
Practice Address - Street 2:INTERNAL MEDICINE
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5051
Practice Address - Country:US
Practice Address - Phone:804-828-3349
Practice Address - Fax:804-828-4670
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101257263207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology