Provider Demographics
NPI:1225190424
Name:GOSS, MARAGRET L (DO)
Entity Type:Individual
Prefix:DR
First Name:MARAGRET
Middle Name:L
Last Name:GOSS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:P.O. BOX 669
Mailing Address - Street 2:
Mailing Address - City:GRUNDY
Mailing Address - State:VA
Mailing Address - Zip Code:24614-0669
Mailing Address - Country:US
Mailing Address - Phone:276-935-1167
Mailing Address - Fax:276-935-1219
Practice Address - Street 1:1532 SLATE CREEK ROAD,
Practice Address - Street 2:SUITE 106 MEDICAL OFFICE BUILDING
Practice Address - City:GRUNDY
Practice Address - State:VA
Practice Address - Zip Code:24614-0669
Practice Address - Country:US
Practice Address - Phone:276-935-1167
Practice Address - Fax:276-935-1219
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102201972207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0102201972OtherMEDICAL LICENSES
VA289779OtherANTHEM
VAI68420Medicare UPIN