MEDICARE: DR. MICHAEL EDWARD GAUTHIER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208VP0000X	Pain Medicine Physician	0101232575	VA
2	207L00000X	Anesthesiology Physician	0101232575	VA

General Provider Information

NPI Number	:	1477518207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL EDWARD GAUTHIER MD

Provider Business Mailing Address
First Line	:	2221 LEEWARD SHORE DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-1716
Country	:	US
Telephone Number	:	757-641-4718
Fax Number	:

Provider Business Practice Location Address
First Line	:	2221 LEEWARD SHORE DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-1716
Country	:	US
Telephone Number	:	757-641-4718
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	05/01/2025

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