Individual
MARY C. VANDERGRIFT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5673 AIRPORT RD, ROANOKE, VA 24012-1119
(540) 523-8080
(540) 562-8867
Mailing address
213 S JEFFERSON ST STE 1006, ROANOKE, VA 24011-1713
(540) 224-5352
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110002290
VA
Other
Enumeration date
10/24/2006
Last updated
04/20/2023
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