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General NPI Number Information
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NPI Number | 1306875497
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Entity Type | Organization
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Legal Business Name | WESTSIDE MEDICAL, P.C.
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Dates
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Enumeration Date | 07/01/2006
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Last Update Date | 06/05/2024
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Provider Practice Location Address
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Address Line | 1601 OLDE WILLIAM ST STE B
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City | FREDERICKSBURG
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State | VA
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Zip | 22401-5525
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Country | US
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Telephone | 540-371-4488
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Fax | 540-755-2459
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Provider Business Mailing Address
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Address Line | 6307 HARRISON RD
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City | FREDERICKSBURG
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State | VA
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Zip | 22407-6363
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Country | US
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Telephone | 540-702-8320
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN-OWNER
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Name | DR. MATTHEW J HENGY
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Credential | D.O.
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Telephone | 540-287-9066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0102200840
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License Number State | VA
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