Basic Information
| Provider Information | |||||||||
| NPI: | 1053687681 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DANVILLE VASCULAR ACCESS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 WEST SWEDESFORD ROAD | ||||||||
| Address2: | BLDG 3 SUITE 300 | ||||||||
| City: | BERWYN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193121172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106448900 | ||||||||
| FaxNumber: | 6106448909 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 MEMORIAL DR | ||||||||
| Address2: | SUITE C | ||||||||
| City: | DANVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245411679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4347926826 | ||||||||
| FaxNumber: | 4347926829 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2012 | ||||||||
| LastUpdateDate: | 03/28/2012 | ||||||||
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| AuthorizedOfficialLastName: | SHIKORSKY | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT OF FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 6106448900 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.