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NPI Code Detail

MEDICARE: MARY GAYLE SWEET MD

MEDICARE: MARY GAYLE SWEET MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician0101-227058VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1588655807
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY GAYLE SWEET MD
Provider Business Mailing Address
First Line : 6210 JULIET CT
Second Line :
City : ROANOKE
State : VA
Zip : 24018-7796
Country : US
Telephone Number : 540-776-7738
Fax Number :
Provider Business Practice Location Address
First Line : 1314 PETERS CREEK RD NW
Second Line :
City : ROANOKE
State : VA
Zip : 24017-2500
Country : US
Telephone Number : 540-562-5700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/04/2005
Last Update Date : 08/12/2011

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Directions to “ MARY GAYLE SWEET MD” Practice Location

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