Provider Demographics
NPI:1255504767
Name:DANIEL JOSEPHTHAL MD INC
Entity Type:Organization
Organization Name:DANIEL JOSEPHTHAL MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:JOSEPHTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-977-3621
Mailing Address - Street 1:503 FAULCONER DR
Mailing Address - Street 2:#4A
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-4978
Mailing Address - Country:US
Mailing Address - Phone:434-977-3621
Mailing Address - Fax:434-984-2122
Practice Address - Street 1:503 FAULCONER DR
Practice Address - Street 2:#4A
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-4978
Practice Address - Country:US
Practice Address - Phone:434-977-3621
Practice Address - Fax:434-984-2122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010172672084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA260001669Medicare UPIN
VA0101017267Medicare UPIN