Provider Demographics
NPI:1952314130
Name:HOUGHTON, MICAH T (MD)
Entity Type:Individual
Prefix:
First Name:MICAH
Middle Name:T
Last Name:HOUGHTON
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:9376 ATLEE STATION RD
Mailing Address - Street 2:HANOVER FAMILY PHYSICIANS PC
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116
Mailing Address - Country:US
Mailing Address - Phone:804-730-0990
Mailing Address - Fax:804-730-8752
Practice Address - Street 1:9376 ATLEE STATION RD
Practice Address - Street 2:HANOVER FAMILY PHYSICIANS PC
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116
Practice Address - Country:US
Practice Address - Phone:804-730-0990
Practice Address - Fax:804-730-8752
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-10-18
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Provider Licenses
StateLicense IDTaxonomies
VA0101055297207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G28365Medicare UPIN