Provider Demographics
NPI:1922070879
Name:BLUESTEIN, DANIEL ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ALLEN
Last Name:BLUESTEIN
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:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-5955
Mailing Address - Fax:757-446-5196
Practice Address - Street 1:825 FAIRFAX AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-446-5955
Practice Address - Fax:757-446-5196
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101033393207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC05186OtherBC/BS
VAPAROtherAETNA
VA-002 -003OtherTRICARE/CHAMPUS
VA2180430OtherUHC/MAMSI
VAPAROtherUSA MANAGED CARE
VA081921OtherANTHEM
NC8905186Medicaid
VAPAROtherCIGNA
VAPAROtherVA HEALTH NETWORK
VAPAROtherMULTIPLAN
VA005625475Medicaid
VA11093OtherSENTARA
VA005612870Medicaid
VAPAROtherVIRGINIA PREMIER HEALTH
VAPAROtherCORVEL/CORCARE
VAPAROtherFIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY
VA080046369Medicare PIN
NC05186OtherBC/BS
VAB10079Medicare UPIN