Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 0101244971 | VA |
Y | 2080N0001X | Neonatal-Perinatal Doctor | 0101244971 | VA |
NPI | 1023221587 |
---|---|
Provider Name | Brooke D. Vergales |
First Address | Charlottesville, VA 22906-9007 |
Second Address | Charlottesville, VA 22908-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 15/10/2020 |