Healthcare Provider Details

I. General information

NPI: 1770044109
Provider Name (Legal Business Name): FRANCES VIVIAN BERSCAK GRAY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: FRANCES VIVIAN BERSCAK PA

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11803 JEFFERSON AVE STE 205
NEWPORT NEWS VA
23606-2565
US

IV. Provider business mailing address

11803 JEFFERSON AVE STE 205
NEWPORT NEWS VA
23606-2565
US

V. Phone/Fax

Practice location:
  • Phone: 757-736-9860
  • Fax: 757-240-5537
Mailing address:
  • Phone: 757-736-9860
  • Fax: 757-240-5537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110006743
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: