Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | D0020805 | MD |
NPI | 1003035460 |
---|---|
Provider Name | Dr. Sue Vauthier Raver |
First Address | Cumberland, MD 21501-1745 |
Second Address | Cumberland, MD 21501-1745 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D78148 | (02) |