Healthcare Provider Details

I. General information

NPI: 1083008742
Provider Name (Legal Business Name): WINCHESTER ORTHOPAEDIC ASSOCIATES, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2015
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 AMHERST ST
WINCHESTER VA
22601-2808
US

IV. Provider business mailing address

128 MEDICAL CIR
WINCHESTER VA
22601-3322
US

V. Phone/Fax

Practice location:
  • Phone: 540-667-8975
  • Fax: 540-667-6589
Mailing address:
  • Phone: 540-667-8975
  • Fax: 540-667-6589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS WISE
Title or Position: MD
Credential: MD
Phone: 540-667-8975