Individual
DR. SUSAN KINNISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
101 ELM AVE SE, ROANOKE, VA 24013-2222
(540) 224-4325
Mailing address
213 S JEFFERSON ST STE 625, ROANOKE, VA 24011-1713
(540) 224-5679
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0101227973
VA
208600000X
Surgery Physician
Primary
0101227973
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007313535
—
VA
05
—
1568441046
—
VA
01
—
P00310524
MEDICARE RAILROAD
VA
Enumeration date
01/12/2006
Last updated
08/06/2020
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