Healthcare Provider Details

I. General information

NPI: 1104185081
Provider Name (Legal Business Name): MASARU NEGI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2012
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1870 AMHERST ST STE 3A
WINCHESTER VA
22601-2841
US

IV. Provider business mailing address

220 CAMPUS BLVD STE 210
WINCHESTER VA
22601-2889
US

V. Phone/Fax

Practice location:
  • Phone: 540-536-3228
  • Fax: 540-536-3227
Mailing address:
  • Phone: 540-536-5100
  • Fax: 540-536-0235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number0101279019
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: