Provider Demographics
NPI:1548264377
Name:MAO, VIVIAN H (MD)
Entity type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:H
Last Name:MAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:213 S JEFFERSON ST STE 1006
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-1713
Mailing Address - Country:US
Mailing Address - Phone:540-224-5715
Mailing Address - Fax:540-224-5684
Practice Address - Street 1:102 HIGHLAND AVE SE
Practice Address - Street 2:STE 104
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24013-2255
Practice Address - Country:US
Practice Address - Phone:540-343-4423
Practice Address - Fax:540-343-0495
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101226188174400000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010415691Medicaid
VAVA0103OtherJOHN DEERE
040015083OtherMEDICARE RR
VA299658OtherMAMSI
VA452106OtherANTHEM
VA6502783Medicaid
VA010415683Medicaid
VA010415683Medicaid
VAVA0103OtherJOHN DEERE
VAH23360Medicare UPIN