MEDICARE: DR. SUSAN SHARMILA DHIVIANATHAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	4301098393	VA
2	207Q00000X	Family Medicine Physician	4301098393	MI
3	207Q00000X	Family Medicine Physician	0101255276	VA

General Provider Information

NPI Number	:	1679860639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN SHARMILA DHIVIANATHAN MD

Provider Business Mailing Address
First Line	:	2010 ATHERHOLT RD
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24501-1106
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	414 PARK AVE
Second Line	:
City	:	DANVILLE
State	:	VA
Zip	:	24541-4630
Country	:	US
Telephone Number	:	434-857-3600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2011
Last Update Date	:	04/23/2020

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