Basic Information
Provider Information | |||||||||
NPI: | 1174547061 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BUCHANAN | ||||||||
FirstName: | DANA | ||||||||
MiddleName: | R | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 850 KEMPSVILLE RD STE 200A | ||||||||
Address2: |   | ||||||||
City: | NORFOLK | ||||||||
State: | VA | ||||||||
PostalCode: | 235023920 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7572615910 | ||||||||
FaxNumber: | 7574661611 | ||||||||
Practice Location | |||||||||
Address1: | 850 KEMPSVILLE RD STE 200A | ||||||||
Address2: |   | ||||||||
City: | NORFOLK | ||||||||
State: | VA | ||||||||
PostalCode: | 23502 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7572615910 | ||||||||
FaxNumber: | 7574661611 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/26/2006 | ||||||||
LastUpdateDate: | 12/06/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 041325 | CT | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 207R00000X | 0101246944 | VA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 2V3701 | 01 | CT | HEALTH NET | OTHER | 001413252 | 05 | CT |   | MEDICAID | 010041325CT01 | 01 | CT | ANTHEM BC BS | OTHER | 3452043 | 01 | CT | AETNA US HEALTHCARE | OTHER | P00172171 | 01 | CT | RAILROAD MEDICARE | OTHER | 6B82710 | 01 | NY | EMPIRE BC BS | OTHER | 214042 | 01 | CT | CONNECTICARE | OTHER | 2381489 | 01 | CT | UNITED HEALTHCARE | OTHER | P3089910 | 01 | CT | OXFORD | OTHER |