Provider Demographics
NPI:1376821819
Name:CORNERSTONE SPORTS AND ORTHOPAEDIC SURGERY OF WINCHESTER PC
Entity Type:Organization
Organization Name:CORNERSTONE SPORTS AND ORTHOPAEDIC SURGERY OF WINCHESTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:D
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-532-6712
Mailing Address - Street 1:650 CEDAR CREEK GRADE
Mailing Address - Street 2:SUITE 213
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-6454
Mailing Address - Country:US
Mailing Address - Phone:540-323-7463
Mailing Address - Fax:540-323-7459
Practice Address - Street 1:650 CEDAR CREEK GRADE
Practice Address - Street 2:SUITE 213
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-6454
Practice Address - Country:US
Practice Address - Phone:540-323-7463
Practice Address - Fax:540-323-7459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-02
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810021008Medicaid
VA1376821819Medicaid
WV3810021008Medicaid