Provider Demographics
NPI:1649279340
Name:GAINES, VICTOR D (MD)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:D
Last Name:GAINES
Suffix:
Gender:M
Credentials:MD
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Other - Middle Name:
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Mailing Address - Street 1:2678 SOUTH RD STE 202
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-5254
Mailing Address - Country:US
Mailing Address - Phone:845-790-5700
Mailing Address - Fax:845-790-5719
Practice Address - Street 1:1 COLUMBIA ST
Practice Address - Street 2:VBMC COLUMBIA ST
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-3923
Practice Address - Country:US
Practice Address - Phone:845-454-4700
Practice Address - Fax:845-454-4982
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1541742085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00772261Medicaid
NYA64974Medicare UPIN
NY95A991Medicare ID - Type Unspecified