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General NPI Number Information
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NPI Number | 1700148418
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Entity Type | Individual
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Provider Name | MICHAEL MACKENZIE LEE DORE M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/10/2012
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 620 JOHN PAUL JONES CIR
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City | PORTSMOUTH
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State | VA
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Zip | 23708-2111
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Country | US
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Telephone | 757-953-2223
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Fax |
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Provider Business Mailing Address
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Address Line | 508 FULTON ST
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City | DURHAM
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State | NC
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Zip | 27705-3875
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 2022-03245
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | M-1956
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License Number State | GU
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0101255278
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 0101255278
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License Number State | VA
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