Healthcare Provider Details

I. General information

NPI: 1710130828
Provider Name (Legal Business Name): KRISTIN V KOWALCHIK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2008
Last Update Date: 05/24/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CAMPUS BLVD STE 110
WINCHESTER VA
22601
US

IV. Provider business mailing address

400 CAMPUS BLVD STE 100
WINCHESTER VA
22601-6906
US

V. Phone/Fax

Practice location:
  • Phone: 540-662-1108
  • Fax: 450-540-2244
Mailing address:
  • Phone: 540-662-1108
  • Fax: 450-540-2244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number0101258428
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: