Provider Demographics
NPI:1518924950
Name:JANNUZZI, DANIEL M (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:M
Last Name:JANNUZZI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1712 E. BROAD STREET
Mailing Address - Street 2:JANCARE NEIGHBORHOOD MEDICAL SHOCKOE BOTTOM, LLC
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223
Mailing Address - Country:US
Mailing Address - Phone:804-344-9848
Mailing Address - Fax:804-344-5644
Practice Address - Street 1:1712 E. BROAD STREET
Practice Address - Street 2:JENCARE NEIGHBORHOOD MEDICAL SHOCKOE BOTTOM, LLC
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223
Practice Address - Country:US
Practice Address - Phone:804-344-9848
Practice Address - Fax:804-344-5644
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2015-02-05
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Provider Licenses
StateLicense IDTaxonomies
VA0101043345207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010046343Medicaid
VA010046343Medicaid
VA001775P39Medicare ID - Type Unspecified