Provider Demographics
NPI:1063413466
Name:STRATTON, DWAYNE E (MD)
Entity type:Individual
Prefix:DR
First Name:DWAYNE
Middle Name:E
Last Name:STRATTON
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 1:5104 AUSTIN HEALEY DR
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5817
Mailing Address - Country:US
Mailing Address - Phone:804-405-3299
Mailing Address - Fax:
Practice Address - Street 1:1602 SKIPWITH RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-5205
Practice Address - Country:US
Practice Address - Phone:804-289-4605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101059198207P00000X
TN44156207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA232562OtherBLUE SHIELD
VA005827779Medicaid
VA005830770Medicaid
VA283922OtherBLUE SHIELD
TN1507137Medicaid
VA005827761Medicaid
VA1063413466Medicaid
VA255455OtherBLUE SHIELD
VA283923OtherBLUE SHIELD
VA283922OtherBLUE SHIELD
TN1507137Medicaid
VA255455OtherBLUE SHIELD
VA005827779Medicaid
VA930001590Medicare PIN
VA930001619Medicare PIN