Provider Demographics
NPI:1366462285
Name:WINTERS, CLEOME JANE (MD)
Entity type:Individual
Prefix:
First Name:CLEOME
Middle Name:JANE
Last Name:WINTERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CLEOME
Other - Middle Name:JANE
Other - Last Name:HARRIS-EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10571 TELEGRAPH RD
Mailing Address - Street 2:SUITE110- PEDIATRIC CENTER
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-4652
Mailing Address - Country:US
Mailing Address - Phone:804-266-9616
Mailing Address - Fax:
Practice Address - Street 1:10571 TELEGRAPH RD
Practice Address - Street 2:SUITE110 - PEDIATRIC CENTER
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-4652
Practice Address - Country:US
Practice Address - Phone:804-266-9616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057110174400000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OTH000Medicare UPIN