Basic Information
| Provider Information | |||||||||
| NPI: | 1609874619 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DARRAH | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1204 FENWICK DR | ||||||||
| Address2: | |||||||||
| City: | LYNCHBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245022112 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1330 OAK LN | ||||||||
| Address2: | |||||||||
| City: | LYNCHBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245032513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4342004072 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2005 | ||||||||
| LastUpdateDate: | 02/06/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 0101222950 | VA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 0072-1036-1 | 05 | VA | MEDICAID | 54-2015252 | 01 | TRICARE PROVIDER NUMBER | OTHER | 339622 | 01 | ANTHEM | OTHER | 54-0715569 | 01 | UNITED HEALTHCARE PROVIDE | OTHER | 54-2015252 | 01 | PCHP PROVIDER NUMBER | OTHER | 280684 | 01 | SOUTHERN HEALTH PROVIDER | OTHER | 54-2015252 | 01 | UNITED HEALTHCARE PROVIDE | OTHER | 0072-3083-4 | 05 | VA | MEDICAID | 3202948 | 01 | CIGNA PROVIDER NUMBER | OTHER | 339710 | 01 | ANTHEM | OTHER | 54-0715569 | 01 | PCHP PROVIDER NUMBER | OTHER | 0072-3086-9 | 05 | VA | MEDICAID | 0072-4185-2 | 05 | VA | MEDICAID | 2130249 | 01 | MAMSI HEALTH PLAN PROVIDE | OTHER | 540715569026 | 01 | TRICARE PROVIDER NUMBER | OTHER | 258185 | 01 | ANTHEM PAR/PPO PROVIDER N | OTHER |