Provider Demographics
NPI:1235413675
Name:MORGAN, MARYBETH (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MRS
First Name:MARYBETH
Middle Name:
Last Name:MORGAN
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
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Mailing Address - Street 1:860 OMNI BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4430
Mailing Address - Country:US
Mailing Address - Phone:757-232-8769
Mailing Address - Fax:757-232-8875
Practice Address - Street 1:222 GRAFTON DR
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:VA
Practice Address - Zip Code:23692-2152
Practice Address - Country:US
Practice Address - Phone:757-898-7737
Practice Address - Fax:757-898-8377
Is Sole Proprietor?:No
Enumeration Date:2011-10-04
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0110001869363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant