Basic Information
| Provider Information | |||||||||
| NPI: | 1326201419 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WINTERSTEIN | ||||||||
| FirstName: | JEFFREY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1980 | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235011980 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574467934 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 358 MOWBRAY ARCH | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235072219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574467934 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2008 | ||||||||
| LastUpdateDate: | 10/02/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 0116019378 | VA | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.