1558328450 NPI number — MARY E CABRERA MD

Table of content: MARY E CABRERA MD (NPI 1558328450)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558328450 NPI number — MARY E CABRERA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CABRERA
Provider First Name:
MARY
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558328450
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2010 ATHERHOLT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LYNCHBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24501-1106
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-200-5047
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1418 6TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VICTORIA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23974-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-696-5555
Provider Business Practice Location Address Fax Number:
434-696-1625
Provider Enumeration Date:
04/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  ME69908 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2202780 . This is a "UHC/MAMSI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1695358 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 4555951 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 8202780 . This is a "UHC-PCP" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 61459604 . This is a "BLACK LUNG/FECA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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