MEDICARE: VIRGINIA GYNECOLOGISTS, LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1033145651
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIRGINIA GYNECOLOGISTS, LTD

Provider Business Mailing Address
First Line	:	5675 STONE RD
Second Line	:
City	:	CENTREVILLE
State	:	VA
Zip	:	20120-1667
Country	:	US
Telephone Number	:	703-802-7521
Fax Number	:	703-802-7545

Provider Business Practice Location Address
First Line	:	5675 STONE RD
Second Line	:
City	:	CENTREVILLE
State	:	VA
Zip	:	20120-1667
Country	:	US
Telephone Number	:	703-802-7521
Fax Number	:	703-802-7545

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. REBECA B GRIMM
Credential	:
Telephone Number	:	703-281-5007

Provider Enumeration Date	:	06/24/2006
Last Update Date	:	08/22/2020

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