Provider Demographics
NPI:1679558472
Name:DANDALIDES, STEVEN MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:MICHAEL
Last Name:DANDALIDES
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 1:2349 HAVERSHAM CLOSE
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-1154
Mailing Address - Country:US
Mailing Address - Phone:757-553-2718
Mailing Address - Fax:
Practice Address - Street 1:1850 W ARLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-5704
Practice Address - Country:US
Practice Address - Phone:252-413-6260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301504154207RG0100X
NC38598207RG0100X
IN01086272A207RG0100X
VA0101040588207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA159605OtherBCBS
VA2128264OtherMAMSI/MDIPA
VA2128264OtherUNITEDHEALTHCARE
VA010102995Medicaid
VA15842OtherSENTARA/OPTIMA
NC890565MMedicaid
VAB08143Medicare UPIN
GAP00177560Medicare ID - Type UnspecifiedMEDICARE RAILROAD
VA00W183T05Medicare ID - Type Unspecified