Provider Demographics
NPI:1487799342
Name:DULL, VICKI LORRAINE (MD)
Entity type:Individual
Prefix:DR
First Name:VICKI
Middle Name:LORRAINE
Last Name:DULL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:102 LACY B KING WAY
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-4594
Mailing Address - Country:US
Mailing Address - Phone:540-886-5777
Mailing Address - Fax:540-886-5776
Practice Address - Street 1:102 LACY B KING WAY
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-4594
Practice Address - Country:US
Practice Address - Phone:540-886-5777
Practice Address - Fax:540-886-5776
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY28742207P00000X, 207PE0004X, 207Q00000X, 2083P0500X, 208D00000X
VA0101243458207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1487799342Medicaid
MC11367Medicare PIN
F28952Medicare UPIN