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General NPI Number Information
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NPI Number | 1114174653
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Entity Type | Organization
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Legal Business Name | WINDSOR MEDICINE, PLLC
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Dates
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Enumeration Date | 08/27/2008
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Last Update Date | 08/27/2008
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Provider Practice Location Address
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Address Line | 70 E WINDSOR BLVD
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City | WINDSOR
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State | VA
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Zip | 23487-9443
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Country | US
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Telephone | 757-430-8712
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Fax |
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Provider Business Mailing Address
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Address Line | 2601 SPRINGHAVEN DR
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City | VIRGINIA BEACH
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State | VA
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Zip | 23456-3995
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Country | US
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Telephone | 757-430-8712
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. BRYAN D MACK
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Credential | MD
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Telephone | 757-430-8712
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 0101232665
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License Number State | VA
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