Provider Demographics
NPI:1760759518
Name:STATOME, BRIGITTA M (PA-C)
Entity Type:Individual
Prefix:MS
First Name:BRIGITTA
Middle Name:M
Last Name:STATOME
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2013 JEFFERSON ST SW FL 2
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-2419
Mailing Address - Country:US
Mailing Address - Phone:540-982-0237
Mailing Address - Fax:540-982-2719
Practice Address - Street 1:1900 ELECTRIC RD STE 100
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-7474
Practice Address - Country:US
Practice Address - Phone:540-774-8660
Practice Address - Fax:540-774-9195
Is Sole Proprietor?:No
Enumeration Date:2011-11-22
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0110005883363A00000X, 363AM0700X
PAMA055021363A00000X
NY018560-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant