Provider Demographics
NPI:1255527404
Name:BRAGG, MARGO C (PA-C)
Entity type:Individual
Prefix:
First Name:MARGO
Middle Name:C
Last Name:BRAGG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 FALL HILL AVE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3342
Mailing Address - Country:US
Mailing Address - Phone:540-374-5097
Mailing Address - Fax:
Practice Address - Street 1:120 EXECUTIVE CENTER PKWY
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3100
Practice Address - Country:US
Practice Address - Phone:540-374-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001678363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
C01596OtherMEDICARE GROUP NUMBER
C01596OtherMEDICARE GROUP NUMBER
VAQ10149Medicare UPIN