Healthcare Provider Details

I. General information

NPI: 1477494565
Provider Name (Legal Business Name): ANGEL WYNN MAGETTE RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9159 FRANKTOWN ROAD
FRANKTOWN VA
23354
US

IV. Provider business mailing address

9068 BIRDSNEST DR
BIRDSNEST VA
23307-1426
US

V. Phone/Fax

Practice location:
  • Phone: 757-414-0400
  • Fax: 757-414-0569
Mailing address:
  • Phone: 757-999-4110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0402004136
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: