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NPI Code Detail

MEDICARE: ROY C BLANK M.D.

MEDICARE: ROY C BLANK M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician30777NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1912969817
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROY C BLANK M.D.
Provider Business Mailing Address
First Line : PO BOX 60447
Second Line :
City : CHARLOTTE
State : NC
Zip : 28260-0447
Country : US
Telephone Number : 704-384-7840
Fax Number : 704-384-7830
Provider Business Practice Location Address
First Line : 1995 WELLNESS BLVD
Second Line : SUITE 110, BLDG B
City : MONROE
State : NC
Zip : 28110-7769
Country : US
Telephone Number : 704-384-1140
Fax Number : 704-384-1141
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2006
Last Update Date : 02/07/2013

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Directions to “ ROY C BLANK M.D.” Practice Location

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