Individual
MRS. MIRIAM J MATHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
112 GAINSBOROUGH SQ STE 100, CHESAPEAKE, VA 23320-1706
(757) 410-2287
(757) 410-7747
Mailing address
1301 EXECUTIVE BLVD STE 200, CHESAPEAKE, VA 23320-3671
(757) 842-4481
(757) 312-3135
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110002861
VA
363A00000X
Physician Assistant
MA052816
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50065847
CAPITAL BLUE CROSS
PA
Enumeration date
11/15/2006
Last updated
02/05/2026
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