MEDICARE: IAN BLUBAUGH 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
1	207Q00000X	Family Medicine Physician	0101262937	VA

General Provider Information

NPI Number	:	1952751661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IAN BLUBAUGH M.D.

Provider Business Mailing Address
First Line	:	9A W GRACE ST
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23220-5013
Country	:	US
Telephone Number	:	804-376-9114
Fax Number	:	804-207-8715

Provider Business Practice Location Address
First Line	:	9A W GRACE ST
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23220-5013
Country	:	US
Telephone Number	:	804-376-9114
Fax Number	:	804-207-8715

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2016
Last Update Date	:	11/03/2025

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