Provider Demographics
NPI:1669462081
Name:WINN, GREGORY MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:MARK
Last Name:WINN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 CARPENTER RD
Mailing Address - Street 2:
Mailing Address - City:FT MYER
Mailing Address - State:VA
Mailing Address - Zip Code:22211-1009
Mailing Address - Country:US
Mailing Address - Phone:703-696-2977
Mailing Address - Fax:
Practice Address - Street 1:401 CARPENTER RD
Practice Address - Street 2:
Practice Address - City:FT MYER
Practice Address - State:VA
Practice Address - Zip Code:22211-1009
Practice Address - Country:US
Practice Address - Phone:703-696-2977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-070235207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine