Individual
GAYLAND OLIVER HETHCOAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
190 CAMPUS BLVD, STE 200, WINCHESTER, VA 22601-2872
(540) 662-6135
(540) 662-5845
Mailing address
190 CAMPUS BLVD, STE 200, WINCHESTER, VA 22601-2872
(540) 662-6135
(540) 662-5845
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101231968
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000875693
WV BLUE SHIELD
—
01
—
001717444
WV BLUE SHIELD
—
05
—
005873959
—
VA
05
—
2001954000
—
WV
01
—
2119638
MAMSI PROFESSIONAL
—
01
—
219651
ANTHEM PROFESSIONAL
—
01
—
3810003817
WV MEDICAID GROUP
WV
01
—
53556
SENTARA PROFESSIONAL
—
01
—
C00085
VA MEDICARE B
—
Enumeration date
04/06/2006
Last updated
03/03/2021
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