Individual
MARK R HANABURY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1802 BRAEBURN DR, SALEM, VA 24153-7357
(540) 772-3433
(540) 772-5994
Mailing address
1802 BRAEBURN DR, SALEM, VA 24153-7357
(540) 772-3433
(540) 772-5994
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
0101031266
VA
207Y00000X
Otolaryngology Physician
Primary
0101031266
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010083621
—
VA
01
—
1000135
UNITED HEALTH
—
05
—
1134121338
—
VA
01
—
143175
ANTHEM
—
01
—
243144
SOUTHERN HEALTH
—
01
—
4243474
AETNA
—
01
—
TN0101
JOHN DEERE
—
Enumeration date
06/01/2005
Last updated
12/15/2009
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