Healthcare Provider Details

I. General information

NPI: 1942294129
Provider Name (Legal Business Name): KEVIN EUGENE CULBERT DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 03/19/2021
Certification Date: 02/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 E JUBAL EARLY DR
WINCHESTER VA
22601-5178
US

IV. Provider business mailing address

607 E JUBAL EARLY DR
WINCHESTER VA
22601-5178
US

V. Phone/Fax

Practice location:
  • Phone: 540-536-2200
  • Fax: 540-665-5289
Mailing address:
  • Phone: 540-536-2200
  • Fax: 540-665-5289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3173
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3479
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0102201411
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: