Provider Demographics
NPI:1255331492
Name:GNEWIKOW, DANNY WAYNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DANNY
Middle Name:WAYNE
Last Name:GNEWIKOW
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:743 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-1803
Mailing Address - Country:US
Mailing Address - Phone:434-799-6288
Mailing Address - Fax:434-797-3685
Practice Address - Street 1:743 MAIN ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-1803
Practice Address - Country:US
Practice Address - Phone:434-799-6288
Practice Address - Fax:434-797-3685
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201000057231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1255331492Medicaid
VA640000012OtherMEDICARE PALMETTO GBA PTAN (AUDIOLOGY HEARING AID ASSOCIATES, INC.)
VA640002399OtherMEDICARE RAILROAD PTAN - DANNY W. GNEWIKOW, PH.D., LLC
VA1255331492OtherANTHEM
VA640003503OtherMEDICARE RAILROAD PTAN - AUDIOLOGY HEARING AID ASSOCIATES, INC.
VA640915704OtherMEDICARE PALMETTO GBA PTAN (DANNY W. GNEWIKOW, PH.D., LLC)
640000012Medicare ID - Type UnspecifiedTRAILBLAZERS-LYNCHBURG
541361858OtherPIEDMONT COMMUNITY HEALTH
VA640003503OtherRAILROAD-LYNCHBURG
VA9450017Medicaid
VA9450033Medicaid
640915704Medicare ID - Type UnspecifiedTRAILBLAZERS-DANVILLE
VA248036OtherANTHEM OF VA - DANVILLE
NC740525ZMedicaid