Provider Demographics
NPI:1629013776
Name:DRYSDALE, DANIEL B (MD PC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:B
Last Name:DRYSDALE
Suffix:
Gender:M
Credentials:MD PC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3645 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-7018
Mailing Address - Country:US
Mailing Address - Phone:540-951-0525
Mailing Address - Fax:540-953-1539
Practice Address - Street 1:3645 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-7018
Practice Address - Country:US
Practice Address - Phone:540-951-0525
Practice Address - Fax:540-953-1539
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101029249207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA064462OtherANTHEM PROVIDER NUMBER
VA006374760Medicaid
VA1952631723OtherTYPE II DME NPI CORPORATE DMERC
VA0203460001Medicare NSC
VA006374760Medicaid
VA182936966Medicare PIN