Healthcare Provider Details

I. General information

NPI: 1821226937
Provider Name (Legal Business Name): ANDREW WILLIAM PIELECK D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2009
Last Update Date: 11/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2103 GRAVES MILL RD
FOREST VA
24551-2675
US

IV. Provider business mailing address

2103 GRAVES MILL RD
FOREST VA
24551-2675
US

V. Phone/Fax

Practice location:
  • Phone: 434-316-7199
  • Fax: 434-316-6185
Mailing address:
  • Phone: 434-316-7199
  • Fax: 434-316-6185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number0102203496
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0116021714
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: