Healthcare Provider Details

I. General information

NPI: 1053814129
Provider Name (Legal Business Name): WINCHESTER MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2018
Last Update Date: 01/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 CAMPUS BLVD STE 410
WINCHESTER VA
22601-2872
US

IV. Provider business mailing address

PO BOX 7402
MERRIFIELD VA
22116-7402
US

V. Phone/Fax

Practice location:
  • Phone: 540-536-5980
  • Fax: 412-822-7411
Mailing address:
  • Phone: 800-655-2656
  • Fax: 412-822-7411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: KELLI FAHRENHOLD
Title or Position: CREDENTIALING
Credential:
Phone: 800-655-2656