Healthcare Provider Details

I. General information

NPI: 1487739595
Provider Name (Legal Business Name): PREVENTIVE WOMEN'S HEALTH GYN & INFERTILITY, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 08/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

874 FOX DR
WINCHESTER VA
22603-8613
US

IV. Provider business mailing address

874 FOX DR
WINCHESTER VA
22603-8613
US

V. Phone/Fax

Practice location:
  • Phone: 540-662-0990
  • Fax: 540-678-8054
Mailing address:
  • Phone: 540-662-0990
  • Fax: 540-678-8054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number0101043969
License Number StateVA

VIII. Authorized Official

Name: DR. MARK WILLIAM DOERING
Title or Position: OWNER
Credential: M.D.
Phone: 540-662-0990