Provider Demographics
NPI:1174860415
Name:BLAND, SUSAN MONTELLA (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MONTELLA
Last Name:BLAND
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 1:709 CLANDON DR
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-5036
Mailing Address - Country:US
Mailing Address - Phone:423-378-3267
Mailing Address - Fax:423-378-3343
Practice Address - Street 1:709 CLANDON DR
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-5036
Practice Address - Country:US
Practice Address - Phone:423-378-3267
Practice Address - Fax:423-378-3343
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000016781207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine