Provider Demographics
NPI:1508074220
Name:CULBERT, DANIELLE JACQUELYN (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:JACQUELYN
Last Name:CULBERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5839 HARBOUR VIEW BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3315
Mailing Address - Country:US
Mailing Address - Phone:757-483-6100
Mailing Address - Fax:757-483-2203
Practice Address - Street 1:5839 HARBOUR VIEW BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3315
Practice Address - Country:US
Practice Address - Phone:757-483-6100
Practice Address - Fax:757-483-2203
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101244836207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1508074220Medicaid
VA4143404OtherCIGNA
VA479689OtherANTHEM
VA10101124OtherOPTIMA
VAVV7840AOtherMEDICARE
VA9238941OtherAETNA