Healthcare Provider Details

I. General information

NPI: 1003812082
Provider Name (Legal Business Name): BETH M WINKE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 09/17/2021
Certification Date: 09/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 EDEN WAY N STE 102
CHESAPEAKE VA
23320-0745
US

IV. Provider business mailing address

808 EDEN WAY N STE 102
CHESAPEAKE VA
23320-0745
US

V. Phone/Fax

Practice location:
  • Phone: 757-216-4030
  • Fax: 757-216-4029
Mailing address:
  • Phone: 757-216-4030
  • Fax: 757-216-4029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number0101054160
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: