Provider Demographics
NPI:1114980737
Name:DOULL, GREGORY HARRISON (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:HARRISON
Last Name:DOULL
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 1:1011 EAST JEFFERSON STREET
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-5354
Mailing Address - Country:US
Mailing Address - Phone:434-977-7950
Mailing Address - Fax:434-295-4470
Practice Address - Street 1:1011 EAST JEFFERSON STREET
Practice Address - Street 2:SUITE 202
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-5354
Practice Address - Country:US
Practice Address - Phone:434-977-7950
Practice Address - Fax:434-295-4470
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101044276207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA090968OtherBCBS
VA006057586Medicaid
F10230Medicare UPIN
VA110003841Medicare PIN