Provider Demographics
NPI:1558328450
Name:CABRERA, MARY E (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:CABRERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 ATHERHOLT RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-1106
Mailing Address - Country:US
Mailing Address - Phone:434-200-5047
Mailing Address - Fax:
Practice Address - Street 1:1418 6TH STREET
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:VA
Practice Address - Zip Code:23974-0000
Practice Address - Country:US
Practice Address - Phone:434-696-5555
Practice Address - Fax:434-696-1625
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME69908207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2202780OtherUHC/MAMSI
VA1695358OtherCIGNA
VA4555951OtherAETNA
VA8202780OtherUHC-PCP
VA61459604OtherBLACK LUNG/FECA
VA8202780OtherUHC-PCP
VAP00720939Medicare PIN
VA61459604OtherBLACK LUNG/FECA
VA019243C59Medicare PIN