Healthcare Provider Details

I. General information

NPI: 1396701173
Provider Name (Legal Business Name): PRIMEDOC OF WINCHESTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 03/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 AMHERST ST
WINCHESTER VA
22601-2808
US

IV. Provider business mailing address

PO BOX 751406
CHARLOTTE NC
28275-1406
US

V. Phone/Fax

Practice location:
  • Phone: 843-237-3378
  • Fax: 843-237-5073
Mailing address:
  • Phone: 843-237-3378
  • Fax: 843-237-5073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT REYNOLDS
Title or Position: PRESIDENT
Credential: MD
Phone: 828-210-3260