Individual
MARY-ELLEN MICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
105 MCDONALD ST, BLACKSBURG, VA 24060-3420
(540) 552-5545
(540) 552-5568
Mailing address
105 MCDONALD ST, BLACKSBURG, VA 24060-3420
(540) 552-5545
(540) 552-5568
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0102203412
VA
207R00000X
Internal Medicine Physician
0116022638
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1124339924
—
VA
Enumeration date
06/25/2010
Last updated
03/09/2026
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