Individual
AMRITA DE ZOYSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
200 HIGH ST, BRIDGEWATER, VA 22812-1114
(540) 828-2694
Mailing address
200 HIGH ST, BRIDGEWATER, VA 22812-1114
(540) 828-2694
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101253865
VA
390200000X
Student in an Organized Health Care Education/Training Program
57-017500
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
VVA749A
MEDICARE PTAN
VA
Enumeration date
06/25/2010
Last updated
04/14/2014
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