Basic Information
| Provider Information | |||||||||
| NPI: | 1437140571 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JANYJA | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 13306 | ||||||||
| Address2: | |||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240323306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403450289 | ||||||||
| FaxNumber: | 5403459569 | ||||||||
| Practice Location | |||||||||
| Address1: | 5115 BERNARD DR | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240184357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403450289 | ||||||||
| FaxNumber: | 5403459569 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2005 | ||||||||
| LastUpdateDate: | 06/29/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 0101260653 | VA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 35914 | 01 | BLUE CORSS/BLUE SHIELD | OTHER | 259797700 | 05 | FL | MEDICAID |