Provider Demographics
NPI:1225103567
Name:THREAT, DANIEL T JR (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:T
Last Name:THREAT
Suffix:JR
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 1:4619 GREGORYS CHARTER CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23236-1062
Mailing Address - Country:US
Mailing Address - Phone:804-379-5488
Mailing Address - Fax:804-379-5586
Practice Address - Street 1:4619 GREGORYS CHARTER CT
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23236-1062
Practice Address - Country:US
Practice Address - Phone:804-379-5488
Practice Address - Fax:804-379-5586
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101054629207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005867100Medicaid
VA930002254Medicare ID - Type UnspecifiedMEDICARE
VA005867100Medicaid