Provider Demographics
NPI:1023069796
Name:LOCKARD, GRETCHEN D (MD)
Entity type:Individual
Prefix:DR
First Name:GRETCHEN
Middle Name:D
Last Name:LOCKARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13911 ST FRANCIS BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-3256
Mailing Address - Country:US
Mailing Address - Phone:804-320-3999
Mailing Address - Fax:804-423-9929
Practice Address - Street 1:13911 ST FRANCIS BLVD STE 101
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114
Practice Address - Country:US
Practice Address - Phone:804-320-3999
Practice Address - Fax:804-423-9929
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00040445207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8295842Medicaid
WA4052LOOtherREGENCE BLUE SHIELD
WA4052LOOtherREGENCE BLUE SHIELD
WAAB28026Medicare ID - Type Unspecified