Healthcare Provider Details

I. General information

NPI: 1730130667
Provider Name (Legal Business Name): WINCHESTER INTERNAL MEDICINE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 06/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 CAMPUS BLVD SUITE 200
WINCHESTER VA
22601-2872
US

IV. Provider business mailing address

190 CAMPUS BLVD SUITE 200
WINCHESTER VA
22601-2872
US

V. Phone/Fax

Practice location:
  • Phone: 540-662-6135
  • Fax: 540-662-5845
Mailing address:
  • Phone: 540-662-6135
  • Fax: 540-662-5845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateVA

VIII. Authorized Official

Name: EDWARD PAUL SMITH
Title or Position: PRESIDENT
Credential: MD
Phone: 540-662-6135