Healthcare Provider Details

I. General information

NPI: 1467623405
Provider Name (Legal Business Name): NEW RIVER VALLEY ORTHOPAEDICS & SPORTS MEDICINE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 PROFESSIONAL PARK DR SE
BLACKSBURG VA
24060-6737
US

IV. Provider business mailing address

120 PROFESSIONAL PARK DR SE
BLACKSBURG VA
24060-6737
US

V. Phone/Fax

Practice location:
  • Phone: 540-552-3601
  • Fax: 540-552-2741
Mailing address:
  • Phone: 540-552-3601
  • Fax: 540-552-2741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateVA

VIII. Authorized Official

Name: DR. MARC S SIEGEL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 540-552-3601