Basic Information
| Provider Information | |||||||||
| NPI: | 1003035460 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAVER | ||||||||
| FirstName: | SUE | ||||||||
| MiddleName: | VAUTHIER | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12501 WILLOWBROOK RD | ||||||||
| Address2: | ALLEGANY COUNTY HEALTH DEPARTMENT | ||||||||
| City: | CUMBERLAND | ||||||||
| State: | MD | ||||||||
| PostalCode: | 215011745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017595001 | ||||||||
| FaxNumber: | 3017775674 | ||||||||
| Practice Location | |||||||||
| Address1: | 12501 WILLOWBROOK RD | ||||||||
| Address2: | ALLEGANY COUNTY HEALTH DEPARTMENT | ||||||||
| City: | CUMBERLAND | ||||||||
| State: | MD | ||||||||
| PostalCode: | 215011745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017595001 | ||||||||
| FaxNumber: | 3017775674 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | D0020805 | MD | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.