Provider Demographics
NPI:1144392044
Name:MATHER, MIRIAM J (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:J
Last Name:MATHER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:MIRIAM
Other - Middle Name:J
Other - Last Name:WITMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:667 KINGSBOROUGH SQ STE 101
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4999
Mailing Address - Country:US
Mailing Address - Phone:757-842-4481
Mailing Address - Fax:757-312-3135
Practice Address - Street 1:112 GAINSBOROUGH SQ STE 100
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-1706
Practice Address - Country:US
Practice Address - Phone:757-410-2287
Practice Address - Fax:757-410-7747
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052816363A00000X
VA0110002861363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50065847OtherCAPITAL BLUE CROSS
PA121005KAGMedicare PIN