Provider Demographics
NPI:1043309313
Name:SHENANDOAH VALLEY FAMILY MEDICINE PC
Entity Type:Organization
Organization Name:SHENANDOAH VALLEY FAMILY MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:B
Authorized Official - Last Name:DWYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-465-3235
Mailing Address - Street 1:136 LINDEN DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-6900
Mailing Address - Country:US
Mailing Address - Phone:540-678-3588
Mailing Address - Fax:540-678-9025
Practice Address - Street 1:116 FOUNDERS WAY
Practice Address - Street 2:SUITE 2
Practice Address - City:STRASBURG
Practice Address - State:VA
Practice Address - Zip Code:22657-3772
Practice Address - Country:US
Practice Address - Phone:540-465-3235
Practice Address - Fax:540-465-3619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA207Q00000X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06919Medicare PIN