Fancy Gap Internal Medicine
Internal Medicine in Fancy Gap, VA. Organization (NPI-2).
NPI number1376940643
StatusActive
Last updated in NPPESJul 21, 2022
Details
- NPI
- 1376940643
- Entity type
- Organization (NPI-2)
- Legal business name
- Fancy Gap Internal Medicine
- Organization subpart
- No
- Enumeration date
- Dec 2, 2014
- Last updated
- Jul 21, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207R00000X | Internal Medicine | – | NC | Yes |
Practice location
1661 Turner Spur RdFancy Gap, VA 24328-4365
Phone 276-728-0735 · Fax 276-728-7717
Mailing address
1661 Turner Spur RdFancy Gap, VA 24328-4365
Phone 276-728-0735 · Fax 276-728-7717
Authorized official
Susan Tracy Roberts
Nurse Practitioner
3367077734
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