Provider Demographics
NPI:1306875497
Name:WESTSIDE MEDICAL, P.C.
Entity type:Organization
Organization Name:WESTSIDE MEDICAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:HENGY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:540-287-9066
Mailing Address - Street 1:6307 HARRISON RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-6363
Mailing Address - Country:US
Mailing Address - Phone:540-702-8320
Mailing Address - Fax:
Practice Address - Street 1:1601 OLDE WILLIAM ST STE B
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-5525
Practice Address - Country:US
Practice Address - Phone:540-371-4488
Practice Address - Fax:540-755-2459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102200840207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09097Medicare PIN