Provider Demographics
NPI:1245209972
Name:RAINE, DUDLEY ALLEN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:DUDLEY
Middle Name:ALLEN
Last Name:RAINE
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 1320
Mailing Address - Street 2:124 AMBRIAR COURT
Mailing Address - City:AMHERST
Mailing Address - State:VA
Mailing Address - Zip Code:24521-1320
Mailing Address - Country:US
Mailing Address - Phone:434-946-9565
Mailing Address - Fax:434-946-2766
Practice Address - Street 1:124 AMBRIAR COURT
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:VA
Practice Address - Zip Code:24521
Practice Address - Country:US
Practice Address - Phone:434-946-9565
Practice Address - Fax:434-946-2766
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-15
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
VA0101044784207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G78979Medicare UPIN
00W262A02Medicare ID - Type Unspecified