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General NPI Number Information
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NPI Number | 1093750879
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Entity Type | Organization
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Legal Business Name | GYN ONCOLOGY OF SOUTHWEST VIRGINIA LLC
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Dates
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Enumeration Date | 06/17/2006
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Last Update Date | 11/20/2025
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Provider Practice Location Address
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Address Line | 1900 ELECTRIC RD SUITE 200
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City | SALEM
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State | VA
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Zip | 24153-7474
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Country | US
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Telephone | 540-776-4704
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Fax | 540-769-2453
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Provider Business Mailing Address
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Address Line | 2000 HEALTH PARK DR
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City | BRENTWOOD
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State | TN
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Zip | 37027-4692
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Country | US
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Telephone | 615-373-7406
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Fax |
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Authorized Official
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Title or Position | VP
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Name | SUZANNE BERGAMO
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Credential |
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Telephone | 804-267-5950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number |
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License Number State |
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