Healthcare Provider Details

I. General information

NPI: 1366587198
Provider Name (Legal Business Name): MARIA DOLORES ENCARNACION M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

586 FERNEY CREEK RD NW
WILLIS VA
24380-4652
US

IV. Provider business mailing address

498 FERNEY CREEK RD NW
WILLIS VA
24380-4653
US

V. Phone/Fax

Practice location:
  • Phone: 540-789-7341
  • Fax: 276-236-6370
Mailing address:
  • Phone: 540-789-7341
  • Fax: 276-236-6370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number0101043241
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: