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NPI Code Detail

MEDICARE: DR. MICHAEL D CLAGUE MD

MEDICARE: DR. MICHAEL D CLAGUE MD
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
12085R0202XDiagnostic Radiology Physician0101-029957VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417925280
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL D CLAGUE MD
Provider Business Mailing Address
First Line : 5204 DOGWOOD FOREST DR
Second Line :
City : GLOUCESTER
State : VA
Zip : 23061-3740
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1 HEALTH CIR
Second Line : CARILION STONEWALL JACKSON HOSPITAL, RADIOLOGY DEPT
City : LEXINGTON
State : VA
Zip : 24450-2448
Country : US
Telephone Number : 540-458-3321
Fax Number : 540-458-3333
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2006
Last Update Date : 11/09/2008

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