Individual
DR. SALVATORE KARL BAVUSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
36 LIVELY OAKS RD, LIVELY, VA 22507
(804) 462-5155
(804) 462-5922
Mailing address
PO BOX 1328, KILMARNOCK, VA 22482-1328
(804) 435-8570
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101239782
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1407835937
—
VA
01
—
410368
ANTHEM BC/BS
VA
Enumeration date
01/12/2006
Last updated
08/06/2014
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