Healthcare Provider Details

I. General information

NPI: 1497591739
Provider Name (Legal Business Name): DONALD LEE STOTTLEMYER JR. PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2024
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1870 AMHERST ST STE 2B
WINCHESTER VA
22601-2841
US

IV. Provider business mailing address

220 CAMPUS BLVD STE 320
WINCHESTER VA
22601-2889
US

V. Phone/Fax

Practice location:
  • Phone: 540-536-7790
  • Fax:
Mailing address:
  • Phone: 540-536-5100
  • Fax: 540-536-0235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110011004
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: