Healthcare Provider Details

I. General information

NPI: 1780728238
Provider Name (Legal Business Name): MARY SUSAN OLNEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 HUFFMAN MILL RD ALAMANCE REGIONAL MEDICAL CENTER LABORATORY
BURLINGTON NC
27215-8700
US

IV. Provider business mailing address

115 BLACKCHERRY LN
CHAPEL HILL NC
27514-1613
US

V. Phone/Fax

Practice location:
  • Phone: 336-538-7831
  • Fax: 336-538-6585
Mailing address:
  • Phone: 336-538-7831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number30692
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: