Healthcare Provider Details

I. General information

NPI: 1649026485
Provider Name (Legal Business Name): NRV INTERNAL MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2024
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 WEST MAIN STREET
RADFORD VA
24141
US

IV. Provider business mailing address

PO BOX 8310
ROANOKE VA
24014-0310
US

V. Phone/Fax

Practice location:
  • Phone: 540-838-8300
  • Fax: 540-838-8030
Mailing address:
  • Phone: 540-345-3556
  • Fax: 540-566-3889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RANIA ROSBOROUGH
Title or Position: PRESIDENT
Credential: MD
Phone: 540-838-8300