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General NPI Number Information
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NPI Number | 1912292400
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Entity Type | Individual
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Provider Name | EMILY SUSAN REARDON M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/13/2011
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 1880 AMHERST ST STE 300
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City | WINCHESTER
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State | VA
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Zip | 22601-2917
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Country | US
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Telephone | 540-536-6721
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Fax | 540-536-6724
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Provider Business Mailing Address
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Address Line | 220 CAMPUS BLVD STE 320
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City | WINCHESTER
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State | VA
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Zip | 22601-2889
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Country | US
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Telephone | 540-536-5100
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Fax | 540-536-0235
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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 | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 0101272360
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License Number State | VA
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