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General NPI Number Information
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NPI Number | 1144747528
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Entity Type | Organization
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Legal Business Name | SUSAN L CAVENDER M.D. PLLC
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Dates
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Enumeration Date | 08/25/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1115 LEE ST E
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City | CHARLESTON
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State | WV
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Zip | 25301-2412
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Country | US
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Telephone | 304-357-4512
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Fax | 304-357-4514
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Provider Business Mailing Address
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Address Line | 1115 LEE ST E
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City | CHARLESTON
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State | WV
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Zip | 25301-2412
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Country | US
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Telephone | 304-357-4512
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Fax | 304-357-4514
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SUSAN L CAVENDER
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Credential | MD
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Telephone | 304-357-4512
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 14497
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License Number State | WV
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