Individual
MARC GAINES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1860 COLONIAL MEDICAL CT, VIRGINIA BEACH, VA 23454-3035
(757) 481-1113
(757) 496-3822
Mailing address
PO BOX 7068, PORTSMOUTH, VA 23707-0068
(757) 686-3542
(757) 686-0230
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101027364
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005801338
—
VA
01
—
27260
SENTARA/OPTIMA
VA
01
—
437513
ANTHEM
VA
01
—
541595397
AETNA
VA
Enumeration date
02/10/2006
Last updated
12/02/2014
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