Healthcare Provider Details

I. General information

NPI: 1558573501
Provider Name (Legal Business Name): MARY CATHERINE WIMER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BOARS HEAD LN
CHARLOTTESVILLE VA
22903-4610
US

IV. Provider business mailing address

707 DRY BRIDGE RD
CHARLOTTESVILLE VA
22903-7038
US

V. Phone/Fax

Practice location:
  • Phone: 434-971-2833
  • Fax:
Mailing address:
  • Phone: 434-977-4132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number0101038697
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101038697
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: