Provider Demographics
NPI:1275283939
Name:GHANNOUM, DANNY BASEL (DPM)
Entity type:Individual
Prefix:DR
First Name:DANNY
Middle Name:BASEL
Last Name:GHANNOUM
Suffix:
Gender:M
Credentials:DPM
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Other - Credentials:
Mailing Address - Street 1:PO BOX 825159
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-5159
Mailing Address - Country:US
Mailing Address - Phone:866-626-1540
Mailing Address - Fax:866-386-8526
Practice Address - Street 1:222 WALNUT AVE SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4723
Practice Address - Country:US
Practice Address - Phone:540-344-3668
Practice Address - Fax:540-774-4615
Is Sole Proprietor?:No
Enumeration Date:2022-03-25
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MAPENDING213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist