Basic Information
Provider Information
NPI: 1811127533
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RHODES
FirstName: MARY
MiddleName: MAYNADIER
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 220 CAMPUS BLVD STE 100
Address2:  
City: WINCHESTER
State: VA
PostalCode: 226012888
CountryCode: US
TelephoneNumber: 5405365100
FaxNumber: 5405360235
Practice Location
Address1: 172 LINDEN DR STE 111
Address2:  
City: WINCHESTER
State: VA
PostalCode: 226012892
CountryCode: US
TelephoneNumber: 5405364881
FaxNumber: 5405363274
Other Information
ProviderEnumerationDate: 07/15/2009
LastUpdateDate: 03/31/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/31/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084P0800X0101252801VAY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry

No ID Information.


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