Provider Demographics
NPI:1154476042
Name:WINCHESTER PEDIATRIC CLINIC PC
Entity Type:Organization
Organization Name:WINCHESTER PEDIATRIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:B
Authorized Official - Last Name:EISENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-667-1727
Mailing Address - Street 1:190 CAMPUS BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2872
Mailing Address - Country:US
Mailing Address - Phone:540-667-1727
Mailing Address - Fax:540-722-3373
Practice Address - Street 1:190 CAMPUS BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2872
Practice Address - Country:US
Practice Address - Phone:540-667-1727
Practice Address - Fax:540-722-3373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory