Individual
DR. VIVIAN H. MAO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
102 HIGHLAND AVE SE, STE 104, ROANOKE, VA 24013-2255
(540) 343-4423
(540) 343-0495
Mailing address
213 S JEFFERSON ST STE 1006, ROANOKE, VA 24011-1713
(540) 224-5715
(540) 224-5684
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
0101226188
VA
207Y00000X
Otolaryngology Physician
Primary
0101226188
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010415683
—
VA
05
—
010415691
—
VA
01
—
040015083
MEDICARE RR
—
01
—
299658
MAMSI
VA
01
—
452106
ANTHEM
VA
05
—
6502783
—
VA
01
—
VA0103
JOHN DEERE
VA
Enumeration date
06/09/2005
Last updated
08/11/2022
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