Provider Demographics
NPI:1942261359
Name:RADACK, DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:RADACK
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 1:3806 DUCKLING WALK
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-5969
Mailing Address - Country:US
Mailing Address - Phone:757-373-8852
Mailing Address - Fax:
Practice Address - Street 1:2235 STAPLES MILL RD STE 104
Practice Address - Street 2:AMERICAN ACCESS CARE OF RICHMOND
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-2942
Practice Address - Country:US
Practice Address - Phone:804-355-9729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012298072085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7240180Medicaid
VAG71409Medicare UPIN
VA300002353Medicare ID - Type Unspecified