Provider Demographics
NPI:1790761203
Name:CAMDEN, DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:CAMDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 S JEFFERSON ST STE 300
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-2437
Mailing Address - Country:US
Mailing Address - Phone:540-857-7748
Mailing Address - Fax:540-857-6374
Practice Address - Street 1:612 S JEFFERSON ST STE 300
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24011-2437
Practice Address - Country:US
Practice Address - Phone:540-857-7748
Practice Address - Fax:540-857-6374
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101033197207RG0300X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00276852OtherMEDICARE RAILROAD
VA006095208Medicaid
00W700L26Medicare PIN