Provider Demographics
NPI:1487802849
Name:JUNE B DAFFEH
Entity type:Organization
Organization Name:JUNE B DAFFEH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:B
Authorized Official - Last Name:DAFFEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-435-1106
Mailing Address - Street 1:10 THE PT
Mailing Address - Street 2:
Mailing Address - City:WHITE STONE
Mailing Address - State:VA
Mailing Address - Zip Code:22578-2941
Mailing Address - Country:US
Mailing Address - Phone:804-438-1106
Mailing Address - Fax:
Practice Address - Street 1:10 THE PT
Practice Address - Street 2:
Practice Address - City:WHITE STONE
Practice Address - State:VA
Practice Address - Zip Code:22578-2941
Practice Address - Country:US
Practice Address - Phone:804-438-1106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237512207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty