Individual
HENDRA AUGUSTINUS SANUSI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
535 WESTFIELD RD, SUITE 200, CHARLOTTESVILLE, VA 22901-1725
(434) 973-4040
(434) 974-1780
Mailing address
535 WESTFIELD RD, SUITE 200, CHARLOTTESVILLE, VA 22901-1725
(434) 973-4040
(434) 974-1780
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101047354
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005624665
—
VA
01
—
142898
SOUTHERN HEALTH
VA
01
—
230912
ANTHEM
VA
Enumeration date
07/20/2005
Last updated
11/01/2012
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