Basic Information
| Provider Information | |||||||||
| NPI: | 1730164971 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FELTY | ||||||||
| FirstName: | DANNY | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7101 JAHNKE RD | ||||||||
| Address2: | SUITE 550A | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232254017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8045600490 | ||||||||
| FaxNumber: | 8045603424 | ||||||||
| Practice Location | |||||||||
| Address1: | 7101 JAHNKE RD | ||||||||
| Address2: | SUITE 550A | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232254017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8045600490 | ||||||||
| FaxNumber: | 8045603424 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2005 | ||||||||
| LastUpdateDate: | 02/18/2009 | ||||||||
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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 | 207Q00000X | 0101102681 | VA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 017042P77 | 01 | VA | MEDICARE PTAN | OTHER | 1730164971 | 05 | VA | MEDICAID | P00648486 | 01 | VA | RR MEDICARE | OTHER |