Provider Demographics
NPI:1326051939
Name:GAITHER, MICHAEL DELEON (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DELEON
Last Name:GAITHER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 ALLEN CT
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:VA
Mailing Address - Zip Code:23847-2801
Mailing Address - Country:US
Mailing Address - Phone:423-605-7853
Mailing Address - Fax:
Practice Address - Street 1:8500 AL PHILPOTT HWY
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-1495
Practice Address - Country:US
Practice Address - Phone:276-226-9925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1205207R00000X
NC9600917207R00000X
VA102037015207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F95070Medicare UPIN