Healthcare Provider Details

I. General information

NPI: 1396744488
Provider Name (Legal Business Name): GREGORY S BYRD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 09/08/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

759 S MAIN ST STE. 300
WOODSTOCK VA
22664-1127
US

IV. Provider business mailing address

220 CAMPUS BLVD STE 200
WINCHESTER VA
22601-2889
US

V. Phone/Fax

Practice location:
  • Phone: 540-459-1540
  • Fax: 540-459-1486
Mailing address:
  • Phone: 540-536-5100
  • Fax: 540-536-0235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101052702
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: