Provider Demographics
NPI:1275501223
Name:UENO, WINSTON M (MD)
Entity Type:Individual
Prefix:
First Name:WINSTON
Middle Name:M
Last Name:UENO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4660 KENMORE AVE
Mailing Address - Street 2:SUITE 1018
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-1306
Mailing Address - Country:US
Mailing Address - Phone:571-483-1800
Mailing Address - Fax:703-823-5723
Practice Address - Street 1:4660 KENMORE AVE
Practice Address - Street 2:SUITE 1018
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-1306
Practice Address - Country:US
Practice Address - Phone:571-483-1800
Practice Address - Fax:703-823-5723
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101022194207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1275501223Medicaid
VA043380F90Medicare PIN
VA830000065Medicare PIN
VA900001328Medicare PIN
VA1275501223Medicaid
VAP00668904Medicare PIN