| NPI | 1851364152 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OTIS BLACKWOOD Practice Administrator 540-772-3672 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207KA0200X Allergy & Immunology, Allergy (Licence: VA 0101048225) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 01022201115) |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: VA 0101034748) | |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2020-08-22 |