Provider Demographics
NPI:1982623385
Name:GREGORCZYK, MARGARET J (MD)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:J
Last Name:GREGORCZYK
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:PO BOX 884
Mailing Address - Street 2:
Mailing Address - City:RAVEN
Mailing Address - State:VA
Mailing Address - Zip Code:24639-0884
Mailing Address - Country:US
Mailing Address - Phone:276-345-4433
Mailing Address - Fax:276-345-4424
Practice Address - Street 1:5453 GOVERNOR G C PEERY HWY
Practice Address - Street 2:
Practice Address - City:RAVEN
Practice Address - State:VA
Practice Address - Zip Code:24639-9533
Practice Address - Country:US
Practice Address - Phone:276-345-4433
Practice Address - Fax:276-345-4424
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101045863207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAE58047Medicare UPIN
VA002159R87Medicare ID - Type Unspecified