Healthcare Provider Details

I. General information

NPI: 1295846202
Provider Name (Legal Business Name): WINCHESTER PEDIATRIC CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 CAMPUS BLVD STE 400
WINCHESTER VA
22601-2872
US

IV. Provider business mailing address

190 CAMPUS BLVD STE 400
WINCHESTER VA
22601-2872
US

V. Phone/Fax

Practice location:
  • Phone: 540-667-1727
  • Fax: 540-722-3373
Mailing address:
  • Phone: 540-667-1727
  • Fax: 540-722-3373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DOROTHY B EISENBERG
Title or Position: PRESIDENT
Credential: MD
Phone: 540-667-1727