Provider Demographics
NPI:1831188986
Name:CUTTER, DOUGLAS N (MD)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:N
Last Name:CUTTER
Suffix:
Gender:M
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:PO BOX 91734
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23291-1734
Mailing Address - Country:US
Mailing Address - Phone:804-358-6100
Mailing Address - Fax:804-560-6505
Practice Address - Street 1:9000 STONY POINT PKWY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-1900
Practice Address - Country:US
Practice Address - Phone:804-560-8945
Practice Address - Fax:804-560-7342
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101039664207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010132240Medicaid
VA010132240Medicaid
VA00W413C01Medicare ID - Type Unspecified
P00418716Medicare PIN