Provider Demographics
NPI:1174547061
Name:BUCHANAN, DANA R (MD)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:R
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 KEMPSVILLE RD STE 200A
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3920
Mailing Address - Country:US
Mailing Address - Phone:757-261-5910
Mailing Address - Fax:757-466-1611
Practice Address - Street 1:850 KEMPSVILLE RD STE 200A
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502
Practice Address - Country:US
Practice Address - Phone:757-261-5910
Practice Address - Fax:757-466-1611
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT041325207Q00000X
VA0101246944207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2V3701OtherHEALTH NET
CT001413252Medicaid
CT010041325CT01OtherANTHEM BC BS
CT3452043OtherAETNA US HEALTHCARE
CTP00172171OtherRAILROAD MEDICARE
NY6B82710OtherEMPIRE BC BS
CT214042OtherCONNECTICARE
CT2381489OtherUNITED HEALTHCARE
CTP3089910OtherOXFORD
CT370001566Medicare ID - Type Unspecified
CT2381489OtherUNITED HEALTHCARE