Healthcare Provider Details

I. General information

NPI: 1558575951
Provider Name (Legal Business Name): B & B MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 01/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 VA AVE NE STE 102
NORTON VA
24273
US

IV. Provider business mailing address

280 VA AVE NE STE 102
NORTON VA
24273
US

V. Phone/Fax

Practice location:
  • Phone: 276-679-0818
  • Fax: 276-679-9128
Mailing address:
  • Phone: 276-679-0818
  • Fax: 276-679-9128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101029458
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101029458
License Number StateVA

VIII. Authorized Official

Name: THONGDANG BANCHUIN
Title or Position: PRESIDENT
Credential: MD
Phone: 276-679-0818