Provider Demographics
NPI:1598718751
Name:DANVILLE EMERGENCY PHYSICIANS, PC
Entity Type:Organization
Organization Name:DANVILLE EMERGENCY PHYSICIANS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DALLARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-942-9658
Mailing Address - Street 1:80 CEDAR HILLS CIR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-1620
Mailing Address - Country:US
Mailing Address - Phone:919-942-9658
Mailing Address - Fax:
Practice Address - Street 1:142 S MAIN ST
Practice Address - Street 2:EMERGENCY DEPT
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-2922
Practice Address - Country:US
Practice Address - Phone:434-799-2222
Practice Address - Fax:434-799-3857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA465589OtherANTHEM GROUP #
VA465589OtherANTHEM GROUP #
C08682Medicare ID - Type UnspecifiedTRAILBLAZER GROUP #