Individual
DR. DARYL R FANNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4668 PEMBROKE BLVD, SUITE 117, VIRGINIA BEACH, VA 23455-6423
(757) 671-1144
(757) 671-1265
Mailing address
4668 PEMBROKE BLVD, SUITE 117, VIRGINIA BEACH, VA 23455-6423
(757) 671-1144
(757) 671-1265
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
0101045547
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007213905
—
VA
01
—
380544
ANTHEM BC/BS PROV#
VA
05
—
890524Y
—
NC
Enumeration date
11/29/2005
Last updated
04/22/2008
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