Provider Demographics
NPI:1679877757
Name:BETH A OMUNDSEN MD PLC
Entity type:Organization
Organization Name:BETH A OMUNDSEN MD PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:OMUNDSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-723-4994
Mailing Address - Street 1:3050 VALLEY AVE
Mailing Address - Street 2:SUITE 100-102
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2668
Mailing Address - Country:US
Mailing Address - Phone:540-723-4994
Mailing Address - Fax:540-723-9699
Practice Address - Street 1:3050 VALLEY AVE
Practice Address - Street 2:SUITE 100-102
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2668
Practice Address - Country:US
Practice Address - Phone:540-723-4994
Practice Address - Fax:540-723-9699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty