Provider Demographics
NPI:1992705677
Name:MACDOUGALL, ELAINE C (MD)
Entity type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:C
Last Name:MACDOUGALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 SELMA DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-3834
Mailing Address - Country:US
Mailing Address - Phone:540-678-2800
Mailing Address - Fax:
Practice Address - Street 1:104 SELMA DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3834
Practice Address - Country:US
Practice Address - Phone:540-678-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101057755207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA020233OtherSOUTHERN HEALTH
VA502800OtherNCPPO
VA005616557Medicaid
WV0045122000Medicaid
VAC00075OtherMEDICARE GROUP
VA2119587OtherMAMSI
VA139296OtherANTHEM BCBS
VA36996OtherSENTARA
VA080007644Medicare ID - Type UnspecifiedTRAILBLAZERS HEALTH
VA020233OtherSOUTHERN HEALTH
WV0045122000Medicaid