Provider Demographics
NPI:1639140569
Name:PILLSBURY DAVID, SUSAN LEWIS (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:LEWIS
Last Name:PILLSBURY DAVID
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 POCOSHOCK PL
Mailing Address - Street 2:SUITE 302
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-6345
Mailing Address - Country:US
Mailing Address - Phone:804-674-1985
Mailing Address - Fax:804-276-1048
Practice Address - Street 1:2500 POCOSHOCK PL
Practice Address - Street 2:SUITE 302
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-6345
Practice Address - Country:US
Practice Address - Phone:804-674-1985
Practice Address - Fax:804-276-1048
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101032090174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA231002OtherANTHEM
VA006712673Medicaid
VA541817338OtherFEDERAL TAX ID
VA101050OtherCIGNA
VA4063667OtherAETNA
VA9750OtherSOUTHERN HEALTH
VA1201444OtherUNITED HEALTHCARE
VA9750OtherSOUTHERN HEALTH