Healthcare Provider Details

I. General information

NPI: 1609879444
Provider Name (Legal Business Name): ANGELA RENEE BILLUE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6785 VISCOE RD
RADFORD VA
24141-6905
US

IV. Provider business mailing address

PO BOX 2934
RADFORD VA
24143-2934
US

V. Phone/Fax

Practice location:
  • Phone: 540-230-7423
  • Fax:
Mailing address:
  • Phone: 540-230-7423
  • Fax: 540-633-0957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number84662
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: