Provider Demographics
NPI:1215925961
Name:WORRELL, DAN CARLTON (MD)
Entity type:Individual
Prefix:DR
First Name:DAN
Middle Name:CARLTON
Last Name:WORRELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 TRAINING CENTER RD
Mailing Address - Street 2:
Mailing Address - City:WOODLAWN
Mailing Address - State:VA
Mailing Address - Zip Code:24381-3518
Mailing Address - Country:US
Mailing Address - Phone:276-728-5334
Mailing Address - Fax:276-728-2681
Practice Address - Street 1:22 TRAINING CENTER RD
Practice Address - Street 2:
Practice Address - City:WOODLAWN
Practice Address - State:VA
Practice Address - Zip Code:24381-3518
Practice Address - Country:US
Practice Address - Phone:276-728-5334
Practice Address - Fax:276-728-2681
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-06
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101044109207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010250161Medicaid
VA00W801F01Medicare PIN
VA010250161Medicaid