Provider Demographics
NPI:1609874619
Name:DARRAH, CAROL J (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:J
Last Name:DARRAH
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 1:1204 FENWICK DR
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-2112
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1330 OAK LN
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24503-2513
Practice Address - Country:US
Practice Address - Phone:434-200-4072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012229502085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0072-1036-1Medicaid
54-2015252OtherTRICARE PROVIDER NUMBER
339622OtherANTHEM
54-0715569OtherUNITED HEALTHCARE PROVIDE
54-2015252OtherPCHP PROVIDER NUMBER
280684OtherSOUTHERN HEALTH PROVIDER
54-2015252OtherUNITED HEALTHCARE PROVIDE
VA0072-3083-4Medicaid
3202948OtherCIGNA PROVIDER NUMBER
339710OtherANTHEM
54-0715569OtherPCHP PROVIDER NUMBER
VA0072-3086-9Medicaid
VA0072-4185-2Medicaid
2130249OtherMAMSI HEALTH PLAN PROVIDE
540715569026OtherTRICARE PROVIDER NUMBER
258185OtherANTHEM PAR/PPO PROVIDER N
339710OtherANTHEM
339622OtherANTHEM
258185OtherANTHEM PAR/PPO PROVIDER N
VA0072-3086-9Medicaid
54-2015252OtherTRICARE PROVIDER NUMBER
280684OtherSOUTHERN HEALTH PROVIDER
VA0072-4185-2Medicaid