Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 0101051213 | VA |
N | 2086S0122X | Plastic and Reconstructive Surgery | 9400735 | NC |
NPI | 1336111491 |
---|---|
Provider Name | Dr. Susan K Buenaventura |
First Address | Alexandria, VA 22304 |
Second Address | Alexandria, VA 22304 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
184854 | ANTHEM (01) | VA |
4819 | BC BS NCA (01) | |
F99513 | (02) |