Individual
MARY BIBRO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1802 BRAEBURN DR, SALEM, VA 24153-7357
(540) 772-5928
(540) 725-5053
Mailing address
PO BOX 2311, CHATSWORTH, CA 91313-2311
(818) 718-9500
(818) 718-9507
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0101039251
VA
207ZP0101X
Anatomic Pathology Physician
0101039251
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00W678L04
MEDICARE - LGP
—
Enumeration date
07/15/2005
Last updated
08/16/2007
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