Provider Demographics
NPI:1407823693
Name:CANTRELL, ELEANOR SUE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELEANOR
Middle Name:SUE
Last Name:CANTRELL
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 1:134 ROBERTS AVE SW
Mailing Address - Street 2:
Mailing Address - City:WISE
Mailing Address - State:VA
Mailing Address - Zip Code:24293-5800
Mailing Address - Country:US
Mailing Address - Phone:276-328-8000
Mailing Address - Fax:276-376-1020
Practice Address - Street 1:134 ROBERTS AVE SW
Practice Address - Street 2:
Practice Address - City:WISE
Practice Address - State:VA
Practice Address - Zip Code:24293-5800
Practice Address - Country:US
Practice Address - Phone:276-328-8000
Practice Address - Fax:276-376-1020
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101036912207R00000X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB09328Medicare UPIN