Healthcare Provider Details

I. General information

NPI: 1942412663
Provider Name (Legal Business Name): CHERYL L. GAUGHEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 09/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LEE ST 2ND FLOOR
CHARLOTTESVILLE VA
22908-0001
US

IV. Provider business mailing address

LEE ST 2ND FLOOR
CHARLOTTESVILLE VA
22908-0778
US

V. Phone/Fax

Practice location:
  • Phone: 434-924-2283
  • Fax: 434-982-0019
Mailing address:
  • Phone: 434-924-2283
  • Fax: 434-982-0019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0116017448
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0101246264
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: