Provider Demographics
NPI:1306819222
Name:GAINES, MARC (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:GAINES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:PO BOX 7068
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-0068
Mailing Address - Country:US
Mailing Address - Phone:757-686-3542
Mailing Address - Fax:757-686-0230
Practice Address - Street 1:1860 COLONIAL MEDICAL CT
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3035
Practice Address - Country:US
Practice Address - Phone:757-481-1113
Practice Address - Fax:757-496-3822
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101027364207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA437513OtherANTHEM
VA541595397OtherAETNA
VA541595397OtherVIRGINIA HEALTH NETWORK
VA005801338Medicaid
VA541595397OtherTRICARE
VA541595397OtherMID ATLANTIC SOLUTIONS
VA27260OtherSENTARA/OPTIMA
VA541595397OtherCIGNA
VA541595397OtherMID ATLANTIC SOLUTIONS
VA005801338Medicaid