Provider Demographics
NPI:1649717687
Name:MAYER, VIRGINIA (MD)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:MAYER
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 1:9797 WEXFORD CIR
Mailing Address - Street 2:
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746-7121
Mailing Address - Country:US
Mailing Address - Phone:916-501-3777
Mailing Address - Fax:916-781-2930
Practice Address - Street 1:9797 WEXFORD CIR
Practice Address - Street 2:
Practice Address - City:GRANITE BAY
Practice Address - State:CA
Practice Address - Zip Code:95746-7121
Practice Address - Country:US
Practice Address - Phone:916-501-3777
Practice Address - Fax:916-781-2930
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-29
Last Update Date:2017-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG078308207Q00000X
OH35.077129207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine