Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 0101268845 | VA |
Y | 207QA0401X | Family Doctor - Addiction Medicine | 0101268845 | VA |
NPI | 1922531524 |
---|---|
Provider Name | Daniel Solomon Ageze |
First Address | Glen Allen, VA 23060-3314 |
Second Address | Glen Allen, VA 23060-3314 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2017 |
Last Update Date | 13/08/2020 |