MARK R HANABURY JR. (NPI# 1134121338) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134121338 |
| Entity Type | Individual |
| Full Name | MARK R HANABURY JR. |
| Credential | M.D. |
| Practice Address |
1802 Braeburn Dr Salem VA 24153-7357 |
| Practice Telephone | 5407723433 |
| Practice Fax Number | 5407725994 |
| Mailing Telephone | 5407723433 |
| Mailing Fax Number | 5407725994 |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2009-12-15 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 174400000X | Specialist | 0101031266 | VA | Other Service Providers |
| Y | 207Y00000X | Otolaryngology | 0101031266 | VA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| JOHN DEERE | TN0101 | 01 | |
| VA | 1134121338 | 05 | |
| SOUTHERN HEALTH | 243144 | 01 | |
| UNITED HEALTH | 1000135 | 01 | |
| ANTHEM | 143175 | 01 | |
| AETNA | 4243474 | 01 | |
| VA | 010083621 | 05 |
| Street Address |
1802 BRAEBURN DR |
| City | SALEM |
| State | VA |
| Zip Code | 24153-7357 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841851433 | Grace Julia Valiulis | Physician Assistant | 1802 Braeburn Dr, Salem, VA 24153-7357 | 2019-06-24 |
| 1083279376 | Olivia Jayne Darwin | Physician Assistant | 1802 Braeburn Dr, Salem, VA 24153-7357 | 2019-05-02 |
| 1487166088 | Christopher Cutchin Coulter | Nurse Practitioner | 1802 Braeburn Dr, Salem, VA 24153-7357 | 2017-11-04 |
| 1063946358 | Kimberly Charise Martin | Nurse Practitioner | 1802 Braeburn Dr, Salem, VA 24153-7357 | 2017-04-13 |
| 1699215434 | Shannon Michelle Snyder | Physician Assistant | 1802 Braeburn Dr, Salem, VA 24153-7357 | 2017-02-27 |
| 1255875589 | Sarah Markwood | Nurse Practitioner | 1802 Braeburn Dr, Salem, VA 24153-7357 | 2016-12-06 |
| 1437506789 | Nicole Crowder | Registered Nurse | 1802 Braeburn Dr, Salem, VA 24153-7357 | 2016-05-17 |
| 1508228669 | Mohammed Abdul Khadar Siddiqui | Pediatrics | 1802 Braeburn Dr, Salem, VA 24153-7357 | 2016-03-28 |
| 1851757629 | Alisha O Lipes | Physician Assistant | 1802 Braeburn Dr, Salem, VA 24153-7357 | 2016-01-11 |
| 1043685399 | Megan Smith | Nurse Practitioner | 1802 Braeburn Dr, Salem, VA 24153-7357 | 2015-12-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669001228 | Paul Mcguire | Student in an Organized Health Care Education/Training Program | 1906 Braeburn Drive Psychiatry Gme, Salem, VA 24153 | 2020-04-06 |
| 1386114965 | Dynamic Medical LLC | Clinical Medical Laboratory | 1201 Texas Street, Salem, VA 24153 | 2018-11-27 |
| 1134607898 | Renew Psychiatry Services | Psychiatry & Neurology | 177 Electric Rd, Salem, VA 24153 | 2018-08-03 |
| 1508304015 | Samantha Getz | Assisted Living Facility | 3706 Knollridge Rd., Salem, VA 24153 | 2017-02-03 |
| 1518409762 | Melissa Ward | Case Manager/Care Coordinator | 1380 Southside Dr, Suite 100, Salem, VA 24153 | 2016-11-04 |
| 1154729051 | Allison Marie Parry | Physician Assistant | 1336 W Main St., Salem, VA 24153 | 2014-12-09 |
| 1598199457 | Stacy Stanley | Occupational Therapy Assistant | 4812 Moore Rd, Salem, VA 24153 | 2013-08-28 |
| 1366888034 | Dolores Hager | Speech-Language Pathologist | 1851 Harrogate Dr, Salem, VA 24153 | 2013-05-21 |
| 1073850764 | Joel Aaron Nickerson | Specialist/Technologist | 400 Spartan Dr., Salem High School, Salem, VA 24153 | 2013-01-15 |
| 1023387271 | National Diabetic Medical Supply, LLC | Durable Medical Equipment & Medical Supplies | 2153 Apperson Drive, Salem, VA 24153 | 2011-12-16 |
| Find all providers in zip 24153 | ||||
| Taxonomy Code | 207Y00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| An otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems and related structures of the head and neck. An otolaryngologist diagnoses and provides medical and/or surgical therapy or prevention of diseases, allergies, neoplasms, deformities, disorders and/or injuries of the ears, nose, sinuses, throat, respiratory and upper alimentary systems, face, jaws and the other head and neck systems. Head and neck oncology, facial plastic and reconstructive surgery and the treatment of disorders of hearing and voice are fundamental areas of expertise. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Otolaryngology, 2007. http://www.aboto.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Otolaryngology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851825566 | Modern Nose Clinic LLC | Otolaryngology | 340 Vista Ave Se, Ste 100, Salem, OR 97302 | 2017-04-19 |
| 1013286822 | Lawrence Thomas Eschelman | Otolaryngology | 3585 Cherokee Dr S, Salem, OR 97302-9712 | 2011-12-22 |
| 1538462189 | Jon Bruce Hagadorn | Otolaryngology | 3136 W Club Dr, Salem, VA 24153-6823 | 2010-12-20 |
| 1093821969 | Masud Iqbal | Otolaryngology | 156 Route 45, Salem, NJ 08079 | 2006-08-22 |
| 1003889866 | Charles J. Leidner | Otolaryngology | 55 Highland Avuene, Suite 201, Salem, MA 01970 | 2006-02-10 |
| 1851377857 | Charles David Crouse II | Otolaryngology | 1524 Apperson Dr, Salem, VA 24153-7219 | 2005-12-21 |
| 1770588949 | Douglas Skarada | Otolaryngology | 340 Vista Ave Se Ste 100, Salem, OR 97302-4546 | 2005-06-15 |
| 1407850852 | John Donovan | Otolaryngology | 3099 River Rd S, Salem, OR 97302-9754 | 2005-06-13 |
| 1043874696 | Modern Nose Clinic LLC | Otolaryngology | 340 Vista Ave Se Ste 100, Salem, OR 97302-4546 | 2019-04-30 |
| 1013278654 | Jared Hiebert | Otolaryngology | 3099 River Rd S Ste 150, Salem, OR 97302-9754 | 2012-05-30 |
| Find all providers in SALEM | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.