Provider Demographics
NPI:1679573802
Name:DANNY W GNEWIKOW PH D LLC
Entity Type:Organization
Organization Name:DANNY W GNEWIKOW PH D LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:GNEWIKOW
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:434-799-6288
Mailing Address - Street 1:743 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-1803
Mailing Address - Country:US
Mailing Address - Phone:434-799-6288
Mailing Address - Fax:434-797-3685
Practice Address - Street 1:743 MAIN ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-1803
Practice Address - Country:US
Practice Address - Phone:434-799-6288
Practice Address - Fax:434-797-3685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-29
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA9720000078231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
59202OtherSOUTHERN HEALTH SERVICES
148920200OtherDEPARTMENT OF LABOR
VA248032OtherANTHEM OF VA - DANVILLE
VA10113944OtherOPTIMA FAMILY
VA9720000078OtherBUSINESS LICENSE
=========OtherPRIMARY PHYSICIAN CARE