Provider Demographics
NPI:1689626798
Name:WIMBISH, PINK (DPM)
Entity Type:Individual
Prefix:
First Name:PINK
Middle Name:
Last Name:WIMBISH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1934 BRAEBURN DR
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-7302
Mailing Address - Country:US
Mailing Address - Phone:540-982-0253
Mailing Address - Fax:540-982-1996
Practice Address - Street 1:1934 BRAEBURN DR
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-7302
Practice Address - Country:US
Practice Address - Phone:540-982-0253
Practice Address - Fax:540-982-1996
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000859213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00276625OtherRAILROAD MEDICARE
VA480011609OtherRAILROAD MEDICARE
VA181786OtherANTHEM BC BS
VA010191980Medicaid
VA008650P44Medicare ID - Type Unspecified
VAU19393Medicare UPIN
VA010191980Medicaid