Healthcare Provider Details

I. General information

NPI: 1780889543
Provider Name (Legal Business Name): D GREGORY BOTT MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1870 AMHERST ST SUITE 1-B
WINCHESTER VA
22601-2873
US

IV. Provider business mailing address

1870 AMHERST ST SUITE 1-B
WINCHESTER VA
22601-2873
US

V. Phone/Fax

Practice location:
  • Phone: 540-667-6116
  • Fax:
Mailing address:
  • Phone: 540-667-6116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. D GREGORY BOTT
Title or Position: PRES
Credential: M.D.
Phone: 540-667-6116