Organization
SUSAN B HUMPHREYS MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN B. HUMPHREYS M.D. (OWNER)
(276) 523-7943
Entity
Organization
Contact information
Practice address
CARROLL & TATE STREETS, LEBANON, VA 24266
(276) 523-7943
Mailing address
148 CRESTVIEW DR, ABINGDON, VA 24210-2010
(276) 523-7943
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
0101038126
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
236019
ANTHEM BCBS
VA
01
—
DD2295
RR MEDICARE
VA
Enumeration date
09/11/2006
Last updated
10/25/2007
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