Healthcare Provider Details

I. General information

NPI: 1063974830
Provider Name (Legal Business Name): MARY WASHINGTON HEALTHCARE PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 04/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4710 SPOTSYLVANIA PKWY STE 101
FREDERICKSBURG VA
22407-9433
US

IV. Provider business mailing address

2300 FALL HILL AVE STE 509
FREDERICKSBURG VA
22401-3343
US

V. Phone/Fax

Practice location:
  • Phone: 540-373-4602
  • Fax: 540-310-0100
Mailing address:
  • Phone: 540-741-2277
  • Fax: 540-741-1029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. SEAN T. BARDEN
Title or Position: EVP & CFO
Credential:
Phone: 540-741-1494