Healthcare Provider Details

I. General information

NPI: 1306855002
Provider Name (Legal Business Name): STEPHEN AUSBAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 08/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CRMH 1 SOUTH
ROANOKE VA
24033-3367
US

IV. Provider business mailing address

CRMH 1 SOUTH PO BOX 1367
ROANOKE VA
24033-3367
US

V. Phone/Fax

Practice location:
  • Phone: 540-853-0824
  • Fax:
Mailing address:
  • Phone: 540-853-0824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License NumberNC 96-01187
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberNC 96-01187
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number29102
License Number StateSC
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101240947
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: