Provider Demographics
NPI:1326331885
Name:DEAN, DOUGLAS D (DO)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:D
Last Name:DEAN
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 1:6439 GARNERS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-1638
Mailing Address - Country:US
Mailing Address - Phone:803-776-4000
Mailing Address - Fax:
Practice Address - Street 1:6439 GARNERS FERRY RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-1638
Practice Address - Country:US
Practice Address - Phone:803-776-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01022045602081P2900X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1326331885OtherVIRGINIA PREMIER HEALTH PLAN
NC1326331885Medicaid
VA1326331885OtherHUMANA
VA1326331885OtherANTHEM BC/BS
VA1326331885Medicaid
VA1326331885OtherAETNA
VA1326331885OtherTRICARE/CHAMPUS
VA1326331885OtherMULTIPLAN
VA1326331885OtherCIGNA
VA1326331885OtherUNITED HEALTHCARE
VA1326331885OtherCORVEL
VA1326331885OtherCOVENTRY HEALTH CARE
VA1326331885OtherOPTIMA HEALTH
VA1326331885OtherVIRGINIA HEALTH NETWORK
VA1326331885OtherUSA MANAGED CARE
VA1326331885Medicaid