Healthcare Provider Details

I. General information

NPI: 1194740084
Provider Name (Legal Business Name): WOODSTOCK INTERNAL MEDICINE SPECIALISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

759 S MAIN ST SUITE 300
WOODSTOCK VA
22664-1127
US

IV. Provider business mailing address

759 S MAIN ST SUITE 300
WOODSTOCK VA
22664-1127
US

V. Phone/Fax

Practice location:
  • Phone: 540-459-1540
  • Fax: 540-459-1486
Mailing address:
  • Phone: 540-459-1540
  • Fax: 540-459-1486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateVA

VIII. Authorized Official

Name: MR. JERRY A GERMROTH
Title or Position: OWNER
Credential: MD
Phone: 540-459-1540