Healthcare Provider Details

I. General information

NPI: 1033324488
Provider Name (Legal Business Name): MICHAEL A MCCULLOCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 LEE ST
CHARLOTTESVILLE VA
22908-2824
US

IV. Provider business mailing address

1215 LEE ST
CHARLOTTESVILLE VA
22908-2824
US

V. Phone/Fax

Practice location:
  • Phone: 434-924-0211
  • Fax:
Mailing address:
  • Phone: 434-924-0211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number0101262131
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number0101262131
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: