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General NPI Number Information
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NPI Number | 1134121338
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Entity Type | Individual
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Provider Name | MARK R HANABURY JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/01/2005
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Last Update Date | 12/15/2009
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Provider Practice Location Address
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Address Line | 1802 BRAEBURN DR
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City | SALEM
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State | VA
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Zip | 24153-7357
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Country | US
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Telephone | 540-772-3433
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Fax | 540-772-5994
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Provider Business Mailing Address
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Address Line | 1802 BRAEBURN DR
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City | SALEM
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State | VA
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Zip | 24153-7357
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Country | US
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Telephone | 540-772-3433
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Fax | 540-772-5994
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 0101031266
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 0101031266
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License Number State | VA
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