1003811563 NPI number — DR. NEAL S GAITHER MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003811563 NPI number — DR. NEAL S GAITHER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GAITHER
Provider First Name:
NEAL
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003811563
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
220 CAMPUS BLVD STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINCHESTER
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22601-2896
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-536-5100
Provider Business Mailing Address Fax Number:
540-536-0235

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1880 AMHERST STREET
Provider Second Line Business Practice Location Address:
SUITE 100 AND SUITE 200
Provider Business Practice Location Address City Name:
WINCHESTER
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22601-2872
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-662-0306
Provider Business Practice Location Address Fax Number:
855-264-2066
Provider Enumeration Date:
06/20/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RI0011X , with the licence number:  16632 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0011X , with the licence number: 0101047289 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 006048463 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 502795 . This is a "NCPPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0074126000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 082425 . This is a "SOUTHERN HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2119573 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 754451100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 44242 . This is a "COMMUNITYHEALTH SENTARA" identifier . This identifiers is of the category "OTHER".
  • Identifier: C00075 . This is a "MEDICARE GROUP" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 030780 . This is a "ANTHEM BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 9318661 . This is a "MEDICARE GROUP" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".