Healthcare Provider Details

I. General information

NPI: 1801800982
Provider Name (Legal Business Name): STEPHEN BROCK BLANKENSHIP M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 06/23/2021
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16000 JOHNSTON MEMORIAL DR
ABINGDON VA
24211-7659
US

IV. Provider business mailing address

16000 JOHNSTON MEMORIAL DR
ABINGDON VA
24211-7659
US

V. Phone/Fax

Practice location:
  • Phone: 276-258-1100
  • Fax: 276-258-1125
Mailing address:
  • Phone: 276-258-1100
  • Fax: 276-258-1125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101241415
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: