Basic Information
| Provider Information | |||||||||
| NPI: | 1700986502 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WINCHESTER BREAST CENTER PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 CAMPUS BLVD. | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | WINCHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 226016906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405365466 | ||||||||
| FaxNumber: | 5405365475 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 CAMPUS BLVD. | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | WINCHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 226016906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405365466 | ||||||||
| FaxNumber: | 5405365475 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2006 | ||||||||
| LastUpdateDate: | 09/14/2016 | ||||||||
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| AuthorizedOfficialLastName: | MINGHINI | ||||||||
| AuthorizedOfficialFirstName: | ANITA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 5405365466 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 0101052336 | VA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.