Provider Demographics
NPI:1669542569
Name:DEGEN, DOUGLAS B (MD)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:B
Last Name:DEGEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1920
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24402
Mailing Address - Country:US
Mailing Address - Phone:540-886-6259
Mailing Address - Fax:540-885-1696
Practice Address - Street 1:42 LAMBERT STREET SUITE 511
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401
Practice Address - Country:US
Practice Address - Phone:540-886-6259
Practice Address - Fax:540-885-1696
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101034143207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA08069900000OtherSOUTHERN HEALTH
VA6010342Medicaid
VA034159OtherANTHEM
VA08069900000OtherSOUTHERN HEALTH