Healthcare Provider Details

I. General information

NPI: 1528142577
Provider Name (Legal Business Name): RENAL PHYSICIAN ASSOCIATES OF WINCHESTER PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 AMHERST ST STE 201
WINCHESTER VA
22601-6452
US

IV. Provider business mailing address

812 AMHERST ST STE 201
WINCHESTER VA
22601-6452
US

V. Phone/Fax

Practice location:
  • Phone: 540-450-1600
  • Fax: 540-450-0166
Mailing address:
  • Phone: 540-450-1600
  • Fax: 540-450-0166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID E SISSON
Title or Position: PRESIDENT
Credential: MD
Phone: 540-450-1600