Healthcare Provider Details

I. General information

NPI: 1255724456
Provider Name (Legal Business Name): VIOLA WINATA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2015
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10701 ROSEMARY DR
MANASSAS VA
20109-7282
US

IV. Provider business mailing address

10701 ROSEMARY DR
MANASSAS VA
20109-7282
US

V. Phone/Fax

Practice location:
  • Phone: 703-257-3000
  • Fax:
Mailing address:
  • Phone: 703-257-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101261454
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: