Organization
PRIMEDOC OF WINCHESTER PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT REYNOLDS MD (PRESIDENT)
(828) 210-3260
Entity
Organization
Contact information
Practice address
1840 AMHERST ST, WINCHESTER, VA 22601-2808
(843) 237-3378
(843) 237-5073
Mailing address
PO BOX 751406, CHARLOTTE, NC 28275-1406
(843) 237-3378
(843) 237-5073
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0204698000
—
WV
01
—
219017
BLUE CROSS BLUE SHIELD
VA
01
—
CH9829
RAILROAD MEDICARE
VA
Enumeration date
04/21/2006
Last updated
03/16/2009
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