Healthcare Provider Details

I. General information

NPI: 1356322085
Provider Name (Legal Business Name): GIL PAMITTAN BINARAO JR. NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 E STUART DR
GALAX VA
24333-2514
US

IV. Provider business mailing address

770 W RIDGE RD
WYTHEVILLE VA
24382-1187
US

V. Phone/Fax

Practice location:
  • Phone: 276-236-4263
  • Fax:
Mailing address:
  • Phone: 276-223-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024164469
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: