Healthcare Provider Details

I. General information

NPI: 1780811455
Provider Name (Legal Business Name): ABBEY KATHLEEN ILES GORE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2009
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 MEDICAL CIR
WINCHESTER VA
22601-3322
US

IV. Provider business mailing address

128 MEDICAL CIR
WINCHESTER VA
22601-3322
US

V. Phone/Fax

Practice location:
  • Phone: 540-667-8975
  • Fax: 540-667-6589
Mailing address:
  • Phone: 540-667-8975
  • Fax: 540-667-6589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0101255765
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: