Provider Demographics
NPI:1700986502
Name:WINCHESTER BREAST CENTER PC
Entity Type:Organization
Organization Name:WINCHESTER BREAST CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MINGHINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-536-5466
Mailing Address - Street 1:400 CAMPUS BLVD.
Mailing Address - Street 2:SUITE 220
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-6906
Mailing Address - Country:US
Mailing Address - Phone:540-536-5466
Mailing Address - Fax:540-536-5475
Practice Address - Street 1:400 CAMPUS BLVD.
Practice Address - Street 2:SUITE 220
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-6906
Practice Address - Country:US
Practice Address - Phone:540-536-5466
Practice Address - Fax:540-536-5475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101052336208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC10007Medicare PIN