Healthcare Provider Details

I. General information

NPI: 1144289497
Provider Name (Legal Business Name): MICHAEL F. S. DOUGLAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 E MAIN ST SUITE 201
RICHMOND VA
23223-7071
US

IV. Provider business mailing address

2201 E MAIN ST SUITE 201
RICHMOND VA
23223-7071
US

V. Phone/Fax

Practice location:
  • Phone: 804-643-3061
  • Fax: 804-643-3817
Mailing address:
  • Phone: 804-643-3061
  • Fax: 804-643-3817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number0101035553
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: