Healthcare Provider Details

I. General information

NPI: 1689626798
Provider Name (Legal Business Name): PINK WIMBISH D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 11/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1934 BRAEBURN DR
SALEM VA
24153-7302
US

IV. Provider business mailing address

1934 BRAEBURN DR
SALEM VA
24153-7302
US

V. Phone/Fax

Practice location:
  • Phone: 540-982-0253
  • Fax: 540-982-1996
Mailing address:
  • Phone: 540-982-0253
  • Fax: 540-982-1996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0103000859
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: