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NPI Code Detail

MEDICARE: DR. ELAINE C MACDOUGALL MD

MEDICARE: DR. ELAINE C MACDOUGALL 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
1207Q00000XFamily Medicine Physician101057755VA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
5C00075OTHERVAMEDICARE GROUP

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1020233OTHERVASOUTHERN HEALTH
2502800OTHERVANCPPO
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
62119587OTHERVAMAMSI
7139296OTHERVAANTHEM BCBS
836996OTHERVASENTARA

General Provider Information

NPI Number : 1992705677
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ELAINE C MACDOUGALL MD
Provider Business Mailing Address
First Line : 104 SELMA DR
Second Line :
City : WINCHESTER
State : VA
Zip : 22601-3834
Country : US
Telephone Number : 540-678-2800
Fax Number :
Provider Business Practice Location Address
First Line : 104 SELMA DR
Second Line :
City : WINCHESTER
State : VA
Zip : 22601-3834
Country : US
Telephone Number : 540-678-2800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2005
Last Update Date : 09/03/2020

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