MEDICARE: DR. MARK A WINCHESTER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	G34163	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00082832	OTHER	CA	RAILROAD MEDICARE PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780670422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK A WINCHESTER M.D.

Provider Business Mailing Address
First Line	:	1010 HURLEY WAY
Second Line	:	#475
City	:	SACRAMENTO
State	:	CA
Zip	:	95825-3215
Country	:	US
Telephone Number	:	916-561-6818
Fax Number	:	916-561-4263

Provider Business Practice Location Address
First Line	:	5301 F ST
Second Line	:	#117
City	:	SACRAMENTO
State	:	CA
Zip	:	95819-3226
Country	:	US
Telephone Number	:	916-733-1788
Fax Number	:	916-733-1787

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	07/12/2007

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Directions to “ DR. MARK A WINCHESTER M.D.” Practice Location

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