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NPI Code Detail

MEDICARE: MARK R HANABURY JR. M.D.

MEDICARE: MARK R HANABURY JR. M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist0101031266VA
2207Y00000XOtolaryngology Physician0101031266VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14243474OTHERAETNA
2TN0101OTHERJOHN DEERE
3143175OTHERANTHEM
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
61000135OTHERUNITED HEALTH
7243144OTHERSOUTHERN HEALTH

General Provider Information

NPI Number : 1134121338
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK R HANABURY JR. M.D.
Provider Business Mailing Address
First Line : 1802 BRAEBURN DR
Second Line :
City : SALEM
State : VA
Zip : 24153-7357
Country : US
Telephone Number : 540-772-3433
Fax Number : 540-772-5994
Provider Business Practice Location Address
First Line : 1802 BRAEBURN DR
Second Line :
City : SALEM
State : VA
Zip : 24153-7357
Country : US
Telephone Number : 540-772-3433
Fax Number : 540-772-5994
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2005
Last Update Date : 12/15/2009

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