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James S Wiedower

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NPI Number Detailed Information

Provider Information:

Name: James S Wiedower
Gender: M
Provider License Number If Given: 101031439

NPI Information:

NPI: 1144215609
Entity Type
(Individual or Organization):
1-ind
Enumeration Date: 9/12/2005

Last Update Date: 1/16/2019

Provider Business Mailing Address:

Address: 347 WESTSIDE STATION DR
Winchester, VA 22601
Phone Number: 5405360010
Fax Number: 5405360061

Provider Business Practice Location Address:

Address: 1870 AMHERST ST STE C
Winchester, VA 22601
Phone Number: 5405360110
Fax Number: 5405360154

Provider Taxonomy:

Primary: 208600000X
Secondary (if any):
State: VA

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