Healthcare Provider Details

I. General information

NPI: 1518242361
Provider Name (Legal Business Name): MARY WASHINGTON HEALTHCARE PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2011
Last Update Date: 10/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 SAM PERRY BLVD SUITE 314
FREDERICKSBURG VA
22401-4467
US

IV. Provider business mailing address

2300 FALL HILL AVE SUITE 509
FREDERICKSBURG VA
22401-3342
US

V. Phone/Fax

Practice location:
  • Phone: 540-374-3200
  • Fax:
Mailing address:
  • Phone: 540-741-1821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. SEAN BARDEN
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 540-741-1821