Healthcare Provider Details

I. General information

NPI: 1033536461
Provider Name (Legal Business Name): DAVID JACK LECRONIER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2014
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 CAMPUS BLVD STE 201
WINCHESTER VA
22601-2872
US

IV. Provider business mailing address

220 CAMPUS BLVD STE 100
WINCHESTER VA
22601-2896
US

V. Phone/Fax

Practice location:
  • Phone: 540-536-5980
  • Fax: 540-536-5979
Mailing address:
  • Phone: 540-536-5100
  • Fax: 540-536-0235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number0102205912
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: