Healthcare Provider Details

I. General information

NPI: 1477914893
Provider Name (Legal Business Name): EMILY STAPLES D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2016
Last Update Date: 09/21/2025
Certification Date: 09/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 PETERS CREEK RD STE 110
ROANOKE VA
24019-4060
US

IV. Provider business mailing address

6701 PETERS CREEK RD STE 110
ROANOKE VA
24019-4060
US

V. Phone/Fax

Practice location:
  • Phone: 800-765-7130
  • Fax:
Mailing address:
  • Phone: 800-765-7130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34.013055
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO.2157
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0102206658
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: