Provider Demographics
NPI:1497753032
Name:MOUNTCASTLE, MARGARET (NP)
Entity Type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:
Last Name:MOUNTCASTLE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4630 S LABURNUM AVE
Mailing Address - Street 2:STE B
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23231-2441
Mailing Address - Country:US
Mailing Address - Phone:804-222-5511
Mailing Address - Fax:804-222-7041
Practice Address - Street 1:1850 POCAHONTAS TRL
Practice Address - Street 2:
Practice Address - City:QUINTON
Practice Address - State:VA
Practice Address - Zip Code:23141-1657
Practice Address - Country:US
Practice Address - Phone:804-932-4388
Practice Address - Fax:804-932-9860
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024134081363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
S53033Medicare UPIN
VA003803C61Medicare ID - Type Unspecified