Provider Demographics
NPI:1013903723
Name:DUCKWORTH, PAUL FREDERICK JR (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:FREDERICK
Last Name:DUCKWORTH
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2369 STAPLES MILL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-2918
Mailing Address - Country:US
Mailing Address - Phone:804-285-4465
Mailing Address - Fax:804-285-8332
Practice Address - Street 1:8266 ATLEE RD
Practice Address - Street 2:SUITE 133
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-1804
Practice Address - Country:US
Practice Address - Phone:804-730-0792
Practice Address - Fax:804-746-7699
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101038473207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006073093Medicaid
B06650Medicare UPIN
VA100000094Medicare ID - Type Unspecified