Organization Active NPI

GYN Oncology of Southwest Virginia LLC

  • Gynecologic Oncology Physician
  • Salem, VA
National Provider Identifier
1093750879
Registry record updated Nov 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecologic Oncology PhysicianTaxonomy code 207VX0201X
Legal business name
GYN ONCOLOGY OF SOUTHWEST VIRGINIA LLC
Practice address
1900 Electric Rd
Suite 200
Salem, VA 24153-7474
Phone
(540) 776-4704
Fax
(540) 769-2453
NPI assigned
Jun 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Suzanne Bergamo
Title
VP
Phone
(804) 267-5950

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecologic Oncology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207VX0201X Primary

Addresses

Primary practice location

1900 Electric Rd
Suite 200
Salem, VA 24153-7474

Mailing address

2000 Health Park Dr
Brentwood, TN 37027-4692
Phone (615) 373-7406

Other identifiers 2

IdentifierTypeStateIssuer
1093750879MedicaidVA
3810000448MedicaidWV

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

2600 Research Center Dr
Blacksburg, VA 24060
Phone (540) 443-3980

1900 Electric Rd
Ste 200
Salem, VA 24153
Phone (540) 776-4704

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1763596800000",
    "number": "1093750879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 HEALTH PARK DR",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370274692",
            "telephone_number": "615-373-7406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 ELECTRIC RD",
            "address_2": "SUITE 200",
            "city": "SALEM",
            "state": "VA",
            "postal_code": "241537474",
            "telephone_number": "540-776-4704",
            "fax_number": "540-769-2453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GYN ONCOLOGY OF SOUTHWEST VIRGINIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-17",
        "last_updated": "2025-11-20",
        "certification_date": "2025-11-20",
        "status": "A",
        "authorized_official_last_name": "BERGAMO",
        "authorized_official_first_name": "SUZANNE",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "804-267-5950"
    },
    "taxonomies": [
        {
            "code": "207VX0201X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology, Gynecologic Oncology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1093750879",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810000448",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.