=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942491790
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSAN MARIE HANCOCK M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2007
-----------------------------------------------------
Last Update Date | 09/14/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 603 PILOT HOUSE DR STE 240
-----------------------------------------------------
City | NEWPORT NEWS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23606-1904
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-612-5118
-----------------------------------------------------
Fax | 757-873-0246
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 119 JAMES LANDING RD
-----------------------------------------------------
City | NEWPORT NEWS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23606-2052
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-612-5118
-----------------------------------------------------
Fax | 757-873-0246
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2086S0129X
-----------------------------------------------------
Taxonomy Name | Vascular Surgery Physician
-----------------------------------------------------
License Number | 0101242791
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------