Provider Demographics
NPI:1881616134
Name:CHOUGH, DAE B (MD)
Entity type:Individual
Prefix:DR
First Name:DAE
Middle Name:B
Last Name:CHOUGH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5838 HARBOUR VIEW BLVD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-2663
Mailing Address - Country:US
Mailing Address - Phone:757-541-1050
Mailing Address - Fax:757-541-1097
Practice Address - Street 1:5838 HARBOUR VIEW BLVD
Practice Address - Street 2:SUITE 270
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-2663
Practice Address - Country:US
Practice Address - Phone:757-541-1050
Practice Address - Fax:757-541-1097
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2011-08-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101030783207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6082459Medicaid
VAB07569Medicare UPIN
VA6082459Medicaid
VA00X993M02Medicare PIN
VAC01491Medicare ID - Type UnspecifiedMEDICARE GROUP ID