Healthcare Provider Details

I. General information

NPI: 1881019909
Provider Name (Legal Business Name): BLUE RIDGE UROGYNECOLOGY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2014
Last Update Date: 02/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 ELECTRIC RD SUITE 405
ROANOKE VA
24018-4569
US

IV. Provider business mailing address

3800 ELECTRIC RD SUITE 405
ROANOKE VA
24018-4569
US

V. Phone/Fax

Practice location:
  • Phone: 540-480-9719
  • Fax: 540-342-2193
Mailing address:
  • Phone: 540-480-9719
  • Fax: 540-342-2193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES A DAUCHER
Title or Position: PRESIDENT
Credential: MD
Phone: 540-480-9719