MEDICARE: DR. RAE-ANNE DOUGAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	0810004948	VA

General Provider Information

NPI Number	:	1326415837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAE-ANNE DOUGAN

Provider Business Mailing Address
First Line	:	1215 MALL DR
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-4737
Country	:	US
Telephone Number	:	804-594-3960
Fax Number	:

Provider Business Practice Location Address
First Line	:	1215 MALL DR
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-4737
Country	:	US
Telephone Number	:	804-594-3960
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2015
Last Update Date	:	10/03/2016

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