Organization
GILL MEMORIAL ENT CLINIC, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK R HANABURY JR. M.D. (OWNER)
(540) 344-2071
Entity
Organization
Contact information
Practice address
707 S JEFFERSON ST FL 5, ROANOKE, VA 24016-5100
(540) 344-2071
(540) 982-8490
Mailing address
707 S JEFFERSON ST FL 5, ROANOKE, VA 24016-5100
(540) 344-2071
(540) 982-8490
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0101031266
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
143175
ANTHEM
VA
01
—
243144
SOUTHERN HEALTH
VA
01
—
4243474
AETNA
VA
01
—
P00143294
RAILROAD MEDICARE
VA
Enumeration date
06/01/2007
Last updated
07/30/2007
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