Provider Demographics
NPI:1780552554
Name:EILAM, DARRYL ANTOINE
Entity type:Individual
Prefix:
First Name:DARRYL
Middle Name:ANTOINE
Last Name:EILAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4121 COX RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-3321
Mailing Address - Country:US
Mailing Address - Phone:804-887-3062
Mailing Address - Fax:804-887-3062
Practice Address - Street 1:4121 COX RD
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-3321
Practice Address - Country:US
Practice Address - Phone:804-887-3062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-24
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist