Healthcare Provider Details

I. General information

NPI: 1275692253
Provider Name (Legal Business Name): JOHN W.GHRAMM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 02/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1804 W PLAZA DR
WINCHESTER VA
22601-6365
US

IV. Provider business mailing address

1804 W PLAZA DR
WINCHESTER VA
22601-6365
US

V. Phone/Fax

Practice location:
  • Phone: 540-667-3005
  • Fax: 540-667-4741
Mailing address:
  • Phone: 540-667-3005
  • Fax: 540-667-4741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: BRIDGET CARTER
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 540-678-3588