Provider Demographics
NPI:1952690208
Name:DISON, DANIEL I (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:I
Last Name:DISON
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:2117 MCCOMAS WAY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-3908
Mailing Address - Country:US
Mailing Address - Phone:757-668-6700
Mailing Address - Fax:757-668-6690
Practice Address - Street 1:2117 MCCOMAS WAY
Practice Address - Street 2:SUITE 103
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-3908
Practice Address - Country:US
Practice Address - Phone:757-668-6700
Practice Address - Fax:757-668-6690
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2014-06-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101256024208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics