Provider Demographics
NPI:1871586917
Name:SQUIRES, ANNE CHARLOTTE (MD)
Entity type:Individual
Prefix:DR
First Name:ANNE
Middle Name:CHARLOTTE
Last Name:SQUIRES
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:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37662-0009
Mailing Address - Country:US
Mailing Address - Phone:423-857-2066
Mailing Address - Fax:423-857-2070
Practice Address - Street 1:227 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-2715
Practice Address - Country:US
Practice Address - Phone:276-676-3870
Practice Address - Fax:276-628-8927
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101223782207R00000X
TN47033207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010200661Medicaid
VA202760OtherBLACK LUNG
VA0385921OtherUMWA
VA182872OtherANTHEM
VA320218OtherSOUTHERN HEALTH
VA182872OtherANTHEM
VA010200661Medicaid