Healthcare Provider Details

I. General information

NPI: 1518317254
Provider Name (Legal Business Name): YOHANNES GOITE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2016
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
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 210
WINCHESTER VA
22601-2889
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 Number0101278686
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: