Individual
MIA PENDERGRASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
600 GRESHAM DR, 1100, NORFOLK, VA 23507-1904
(757) 388-6234
(757) 388-6201
Mailing address
PO BOX 936, EVMS MEDICAL GROUP, NORFOLK, VA 23501-0936
(757) 388-6200
(757) 388-6201
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
2201001575
VA
Other
Enumeration date
10/28/2014
Last updated
01/07/2015
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