MEDICARE: MRS. MARYBETH MORGAN PHYSICIAN ASSISTANT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	0110001869	VA

General Provider Information

NPI Number	:	1235413675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARYBETH MORGAN PHYSICIAN ASSISTANT

Provider Business Mailing Address
First Line	:	860 OMNI BLVD STE 101
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23606-4430
Country	:	US
Telephone Number	:	757-232-8769
Fax Number	:	757-232-8875

Provider Business Practice Location Address
First Line	:	222 GRAFTON DR
Second Line	:
City	:	GRAFTON
State	:	VA
Zip	:	23692-2152
Country	:	US
Telephone Number	:	757-898-7737
Fax Number	:	757-898-8377

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2011
Last Update Date	:	03/03/2020

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