Provider Demographics
NPI:1538100623
Name:DANIELS, KENNEDY SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNEDY
Middle Name:SCOTT
Last Name:DANIELS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1115 BOULDERS PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4067
Mailing Address - Country:US
Mailing Address - Phone:804-560-5595
Mailing Address - Fax:804-560-9029
Practice Address - Street 1:8200 MEADOWBRIDGE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-2331
Practice Address - Country:US
Practice Address - Phone:804-730-2121
Practice Address - Fax:804-730-0563
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA101035742207XS0114X
VA0101035742207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0900107OtherUNITED HEALTHCARE
VA200020606OtherRAILROAD MEDICARE
VA540885859OtherC&O EMPLOYEES HEALTHCARE
VA540885859OtherCIGNA
VA540885859OtherFOCUS
VA006402321Medicaid
VA285579OtherSOUTHERN HEALTH
VA386528OtherANTHEM WEST END OPERATORY
VA30774OtherSH CARENET
VA540885859OtherCOMPMANAGEMENT
VA2138263OtherUNITED HEALTHCARE MAMSI
VA540885859OtherFIRST HEALTH/CCN
VA540885859OtherPRIVATE HEALTHCARE SYSTEM
VA0536763OtherAETNA HMO
VA540885859OtherCORVEL
VA46416OtherOPTIMA HEALTH
VA052665OtherANTHEM HEALTHKEEPERS
VA1538100623Medicaid
VA200020606OtherRAILROAD MEDICARE
VA2138263OtherUNITED HEALTHCARE MAMSI
VA540885859OtherC&O EMPLOYEES HEALTHCARE