Provider Demographics
NPI:1194784504
Name:STAUNTON MEDICAL ASSOCIATES, INC.
Entity type:Organization
Organization Name:STAUNTON MEDICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:B
Authorized Official - Last Name:DEGEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-886-6259
Mailing Address - Street 1:PO BOX 1920
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24402-1920
Mailing Address - Country:US
Mailing Address - Phone:540-886-6259
Mailing Address - Fax:540-885-1696
Practice Address - Street 1:42 LAMBERT ST
Practice Address - Street 2:SUITE 511
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-2421
Practice Address - Country:US
Practice Address - Phone:540-886-6259
Practice Address - Fax:540-885-1696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC02891OtherGROUP MEDICARE ID #