Healthcare Provider Details

I. General information

NPI: 1407107386
Provider Name (Legal Business Name): RENEE WINSTON DIAL PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RENEE WINSTON DIAL PA

II. Dates (important events)

Enumeration Date: 10/02/2012
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13350 COUNTRY WALK CIR
CARROLLTON VA
23314-3489
US

IV. Provider business mailing address

13350 COUNTRY WALK CIR
CARROLLTON VA
23314-3489
US

V. Phone/Fax

Practice location:
  • Phone: 757-675-8752
  • Fax: 757-500-8555
Mailing address:
  • Phone: 757-675-8752
  • Fax: 757-500-8555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110003953
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: