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General NPI Number Information
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NPI Number | 1356512990
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Entity Type | Organization
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Legal Business Name | WARREN FAMILY PRACTICE, PC
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Dates
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Enumeration Date | 03/21/2008
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Last Update Date | 06/17/2009
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Provider Practice Location Address
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Address Line | 1077 N SHENANDOAH AVE SUITE B
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City | FRONT ROYAL
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State | VA
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Zip | 22630-3546
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Country | US
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Telephone | 540-636-8900
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Fax | 540-636-8920
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Provider Business Mailing Address
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Address Line | 1077 N SHENANDOAH AVE SUITE B
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City | FRONT ROYAL
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State | VA
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Zip | 22630-3546
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Country | US
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Telephone | 540-636-8900
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Fax | 540-636-8920
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAYASHREE VENKATESH
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Credential | MD
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Telephone | 540-636-8900
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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 |
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License Number State |
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