Provider Demographics
NPI:1710084884
Name:ATHENA A HOWARD MD PC
Entity Type:Organization
Organization Name:ATHENA A HOWARD MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ATHENA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-731-1600
Mailing Address - Street 1:PO BOX 4127
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24015-0127
Mailing Address - Country:US
Mailing Address - Phone:540-344-9779
Mailing Address - Fax:540-344-7154
Practice Address - Street 1:701 RANDOLPH ST
Practice Address - Street 2:SUITE 210
Practice Address - City:RADFORD
Practice Address - State:VA
Practice Address - Zip Code:24141-3047
Practice Address - Country:US
Practice Address - Phone:540-731-1600
Practice Address - Fax:540-731-0720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C08170Medicare PIN