Healthcare Provider Details

I. General information

NPI: 1497868459
Provider Name (Legal Business Name): KRISTIN D DEHAVEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 09/23/2021
Certification Date: 09/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 PLAZA DR
WINCHESTER VA
22601-6365
US

IV. Provider business mailing address

1830 PLAZA DR
WINCHESTER VA
22601-6365
US

V. Phone/Fax

Practice location:
  • Phone: 540-665-8414
  • Fax: 540-667-2476
Mailing address:
  • Phone: 540-665-8414
  • Fax: 540-667-2476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101235422
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: