Healthcare Provider Details

I. General information

NPI: 1558328450
Provider Name (Legal Business Name): MARY E CABRERA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 09/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1418 6TH STREET
VICTORIA VA
23974-0000
US

IV. Provider business mailing address

2010 ATHERHOLT RD
LYNCHBURG VA
24501-1106
US

V. Phone/Fax

Practice location:
  • Phone: 434-696-5555
  • Fax: 434-696-1625
Mailing address:
  • Phone: 434-200-5047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME69908
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: