Provider Demographics
NPI:1952631723
Name:DANIEL B. DRYSDALE, MD, PC
Entity Type:Organization
Organization Name:DANIEL B. DRYSDALE, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KASANDRA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:SAUNDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-951-0525
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-30
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101029249207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA064462OtherANTHEM
VA006374760Medicaid
VA064462OtherANTHEM
VA182936966Medicare PIN