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General NPI Number Information
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NPI Number | 1790764009
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Entity Type | Individual
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Provider Name | WAYNE JEFFERSON BERRY II MD
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Gender | Male
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Dates
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Enumeration Date | 01/13/2006
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Last Update Date | 05/22/2025
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Provider Practice Location Address
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Address Line | 759 S MAIN ST
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City | WOODSTOCK
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State | VA
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Zip | 22664-1127
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Country | US
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Telephone | 540-459-1100
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Fax |
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Provider Business Mailing Address
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Address Line | 199 GLENDOBBIN LANE
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City | WINCHESTER
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State | VA
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Zip | 22603
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Country | US
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Telephone | 540-535-1645
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 35098
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101240108
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License Number State | VA
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