Healthcare Provider Details

I. General information

NPI: 1487799342
Provider Name (Legal Business Name): VICKI LORRAINE DULL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 LACY B KING WAY
STAUNTON VA
24401-4594
US

IV. Provider business mailing address

102 LACY B KING WAY
STAUNTON VA
24401-4594
US

V. Phone/Fax

Practice location:
  • Phone: 540-886-5777
  • Fax: 540-886-5776
Mailing address:
  • Phone: 540-886-5777
  • Fax: 540-886-5776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number28742
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number28742
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number28742
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number28742
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number28742
License Number StateKY
# 6
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101243458
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: