Individual
MARILOU V INOCALLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
770 W RIDGE RD, WYTHEVILLE, VA 24382-1046
(276) 223-3200
(276) 223-0617
Mailing address
770 W RIDGE RD, WYTHEVILLE, VA 24382-1046
(276) 223-3200
(276) 223-3061
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
010148106
VA
2084P0804X
Child & Adolescent Psychiatry Physician
0101048106
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004945298
—
VA
01
—
139018
ANTHEM
VA
01
—
166785
VALUEOPTIONS
VA
01
—
247755000
MAGELLAN
—
01
—
260023506
MEDICARE RAILROAD
—
01
—
280113
ANTHEM
VA
01
—
280114
ANTHEM
—
01
—
280116
ANTHEM
VA
Enumeration date
04/13/2006
Last updated
09/18/2013
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