Provider Demographics
NPI:1215034798
Name:WINCHESTER ENDOCRINOLOGY PC
Entity Type:Organization
Organization Name:WINCHESTER ENDOCRINOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUSTAPHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDUL-RAHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-678-0767
Mailing Address - Street 1:172 LINDEN DRIVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2892
Mailing Address - Country:US
Mailing Address - Phone:540-678-0767
Mailing Address - Fax:540-678-0769
Practice Address - Street 1:172 LINDEN DRIVE
Practice Address - Street 2:SUITE 107
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2892
Practice Address - Country:US
Practice Address - Phone:540-678-0767
Practice Address - Fax:540-678-0769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-19
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235673207RE0101X
VA207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VADG2224OtherRR MEDICARE
VAC10008Medicare PIN