Healthcare Provider Details

I. General information

NPI: 1144392044
Provider Name (Legal Business Name): MIRIAM J MATHER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS MIRIAM J WITMER

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 GAINSBOROUGH SQ STE 100
CHESAPEAKE VA
23320-1706
US

IV. Provider business mailing address

667 KINGSBOROUGH SQ STE 101
CHESAPEAKE VA
23320-4999
US

V. Phone/Fax

Practice location:
  • Phone: 757-410-2287
  • Fax: 757-410-7747
Mailing address:
  • Phone: 757-842-4481
  • Fax: 757-312-3135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA052816
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110002861
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: