=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275692253
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOHN W.GHRAMM
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2006
-----------------------------------------------------
Last Update Date | 02/26/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1804 W PLAZA DR
-----------------------------------------------------
City | WINCHESTER
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22601-6365
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-667-3005
-----------------------------------------------------
Fax | 540-667-4741
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1804 W PLAZA DR
-----------------------------------------------------
City | WINCHESTER
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22601-6365
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-667-3005
-----------------------------------------------------
Fax | 540-667-4741
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CREDENTIALING SPECIALIST
-----------------------------------------------------
Name | BRIDGET CARTER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 540-678-3588
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VG0400X
-----------------------------------------------------
Taxonomy Name | Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------