Provider Demographics
NPI:1174013171
Name:SHENANDOAH NEPHROLOGY, PLC
Entity Type:Organization
Organization Name:SHENANDOAH NEPHROLOGY, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:OVERBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-208-7002
Mailing Address - Street 1:4057 QUARLES CT
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:VA
Mailing Address - Zip Code:22801-8717
Mailing Address - Country:US
Mailing Address - Phone:540-208-7002
Mailing Address - Fax:540-217-2339
Practice Address - Street 1:4057 QUARLES CT
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:VA
Practice Address - Zip Code:22801-8717
Practice Address - Country:US
Practice Address - Phone:540-208-7002
Practice Address - Fax:540-217-2339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-15
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty