Healthcare Provider Details

I. General information

NPI: 1023106408
Provider Name (Legal Business Name): GLENNA B. WINNIE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 05/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E. HIRST ROAD SUITE 303
PURCELLVILLE VA
20132
US

IV. Provider business mailing address

2730-B PROSPERITY AVENUE
FAIRFAX VA
22031
US

V. Phone/Fax

Practice location:
  • Phone: 703-226-2290
  • Fax: 703-289-1414
Mailing address:
  • Phone: 703-289-1400
  • Fax: 703-289-1414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberMD34168
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code2080S0012X
TaxonomyPediatric Sleep Medicine Physician
License Number0101234661
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: