Healthcare Provider Details

I. General information

NPI: 1629079371
Provider Name (Legal Business Name): JAMES F TRETTER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 02/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1870 AMHERST ST SUITE 2B
WINCHESTER VA
22601-2873
US

IV. Provider business mailing address

1870 AMHERST ST SUITE 2B
WINCHESTER VA
22601-2873
US

V. Phone/Fax

Practice location:
  • Phone: 540-536-6721
  • Fax: 540-536-6724
Mailing address:
  • Phone: 540-536-6721
  • Fax: 540-536-6724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberOS007358L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number0102204376
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: