Healthcare Provider Details

I. General information

NPI: 1679588461
Provider Name (Legal Business Name): ALBERT CARL WINFIELD II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 05/26/2022
Certification Date: 05/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 EXECUTIVE DR
DANVILLE VA
24541-4101
US

IV. Provider business mailing address

173 EXECUTIVE DR
DANVILLE VA
24541-4101
US

V. Phone/Fax

Practice location:
  • Phone: 434-791-4110
  • Fax: 434-791-4003
Mailing address:
  • Phone: 434-791-4110
  • Fax: 434-791-4003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101232485
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: