Provider Demographics
NPI:1811155542
Name:KNICELY, DAPHNE HARRINGTON (MD)
Entity type:Individual
Prefix:DR
First Name:DAPHNE
Middle Name:HARRINGTON
Last Name:KNICELY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DAPHNE
Other - Middle Name:MELVINA
Other - Last Name:HARRINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9 PINNACLE DR STE A03
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2367
Practice Address - Country:US
Practice Address - Phone:844-472-8711
Practice Address - Fax:844-472-8712
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0101251852207RN0300X
NC2010-000138207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5917483Medicaid
NC163G7OtherBCBSNC
NC163G7OtherBCBSNC
NC5917483Medicaid