Provider Demographics
NPI:1508022351
Name:ALCANTARA, DAVID DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:DANIEL
Last Name:ALCANTARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7007 HARBOUR VIEW BLVD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3657
Mailing Address - Country:US
Mailing Address - Phone:757-215-2784
Mailing Address - Fax:757-215-2728
Practice Address - Street 1:1040 UNIVERSITY BLVD
Practice Address - Street 2:MAST ONE SUITE 200
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703
Practice Address - Country:US
Practice Address - Phone:757-397-6930
Practice Address - Fax:757-393-4864
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-31
Last Update Date:2016-01-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101258337208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVVJ190AMedicare PIN