Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | C10007905 | DE |
N | 2080P0204X | Pediatric Emergency Doctor | C10007905 | DE |
NPI | 1184716938 |
---|---|
Provider Name | Dr. Reza J. Daugherty |
First Address | Charlottesville, VA 22906-9007 |
Second Address | Charlottesville, VA 22908-0816 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2006 |
Last Update Date | 30/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0001830 | (05) | NJ |
1184716938 | (05) | VA |
4100646 | (05) | MD |
H84706 | (02) |