Provider Demographics
NPI:1982133195
Name:WINCHESTER, MICA NATASHA (MD)
Entity Type:Individual
Prefix:DR
First Name:MICA
Middle Name:NATASHA
Last Name:WINCHESTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 W LEHIGH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19132-2664
Mailing Address - Country:US
Mailing Address - Phone:267-866-7211
Mailing Address - Fax:267-202-7398
Practice Address - Street 1:2101 W LEHIGH AVE STE A
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19132-2664
Practice Address - Country:US
Practice Address - Phone:267-866-7211
Practice Address - Fax:267-202-7398
Is Sole Proprietor?:No
Enumeration Date:2017-06-09
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD470815207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine