Healthcare Provider Details

I. General information

NPI: 1497753032
Provider Name (Legal Business Name): MARGARET MOUNTCASTLE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 09/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 POCAHONTAS TRL
QUINTON VA
23141-1657
US

IV. Provider business mailing address

4630 S LABURNUM AVE STE B
RICHMOND VA
23231-2441
US

V. Phone/Fax

Practice location:
  • Phone: 804-932-4388
  • Fax: 804-932-9860
Mailing address:
  • Phone: 804-222-5511
  • Fax: 804-222-7041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024134081
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: