Healthcare Provider Details

I. General information

NPI: 1982623385
Provider Name (Legal Business Name): MARGARET J GREGORCZYK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 02/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5453 GOVERNOR G C PEERY HWY
RAVEN VA
24639-9533
US

IV. Provider business mailing address

PO BOX 884
RAVEN VA
24639-0884
US

V. Phone/Fax

Practice location:
  • Phone: 276-345-4433
  • Fax: 276-345-4424
Mailing address:
  • Phone: 276-345-4433
  • Fax: 276-345-4424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number0101045863
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: