Healthcare Provider Details

I. General information

NPI: 1972956605
Provider Name (Legal Business Name): SHENANDOAH ONCOLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2016
Last Update Date: 02/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CAMPUS BLVD STE 100
WINCHESTER VA
22601-6906
US

IV. Provider business mailing address

1870 AMHERST ST STE F
WINCHESTER VA
22601-2841
US

V. Phone/Fax

Practice location:
  • Phone: 540-662-1108
  • Fax: 540-450-2244
Mailing address:
  • Phone: 540-662-1108
  • Fax: 540-450-2244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0101041458
License Number StateVA

VIII. Authorized Official

Name: LORNA CORRINE GROESE
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 540-662-1108