Basic Information
| Provider Information | |||||||||
| NPI: | 1003811563 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GAITHER | ||||||||
| FirstName: | NEAL | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 220 CAMPUS BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | WINCHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 226012896 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405365100 | ||||||||
| FaxNumber: | 5405360235 | ||||||||
| Practice Location | |||||||||
| Address1: | 1880 AMHERST STREET | ||||||||
| Address2: | SUITE 100 AND SUITE 200 | ||||||||
| City: | WINCHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 226012872 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5406620306 | ||||||||
| FaxNumber: | 8552642066 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2005 | ||||||||
| LastUpdateDate: | 09/14/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0011X | 16632 | WV | N | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 207RI0011X | 0101047289 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 006048463 | 05 | VA | MEDICAID | 502795 | 01 | NCPPO | OTHER | 0074126000 | 05 | WV | MEDICAID | 082425 | 01 | SOUTHERN HEALTH | OTHER | 2119573 | 01 | MAMSI | OTHER | 754451100 | 05 | MD | MEDICAID | 44242 | 01 | COMMUNITYHEALTH SENTARA | OTHER | C00075 | 01 | VA | MEDICARE GROUP | OTHER | 030780 | 01 | VA | ANTHEM BCBS | OTHER | 9318661 | 01 | WV | MEDICARE GROUP | OTHER |