Provider Demographics
NPI:1144297474
Name:GANLEY, DONALD THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:THOMAS
Last Name:GANLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:201 N WASHINGTON HWY
Mailing Address - Street 2:SUITE 306
Mailing Address - City:ASHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23005-1642
Mailing Address - Country:US
Mailing Address - Phone:804-798-1092
Mailing Address - Fax:804-798-1475
Practice Address - Street 1:201 N WASHINGTON HWY
Practice Address - Street 2:SUITE 306
Practice Address - City:ASHLAND
Practice Address - State:VA
Practice Address - Zip Code:23005-1642
Practice Address - Country:US
Practice Address - Phone:804-798-1092
Practice Address - Fax:804-798-1475
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-06
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101044754207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005862876Medicaid
VA110008244Medicare ID - Type Unspecified
VAE93223Medicare UPIN