Healthcare Provider Details

I. General information

NPI: 1831188986
Provider Name (Legal Business Name): DOUGLAS N CUTTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 06/11/2021
Certification Date: 06/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 STONY POINT PKWY
RICHMOND VA
23235-1900
US

IV. Provider business mailing address

PO BOX 91734
RICHMOND VA
23291-1734
US

V. Phone/Fax

Practice location:
  • Phone: 804-560-8945
  • Fax: 804-560-7342
Mailing address:
  • Phone: 804-358-6100
  • Fax: 804-560-6505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101039664
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number0101039664
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: