Healthcare Provider Details

I. General information

NPI: 1396165726
Provider Name (Legal Business Name): CHRISTOPHER MICHAEL BUSCH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2014
Last Update Date: 07/21/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1942 BRAEBURN CIR
SALEM VA
24153-7388
US

IV. Provider business mailing address

1906 BELLEVIEW AVE SE MED ED BLDG 202
ROANOKE VA
24014-1838
US

V. Phone/Fax

Practice location:
  • Phone: 540-444-1240
  • Fax:
Mailing address:
  • Phone: 540-981-8345
  • Fax: 540-344-3812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number0102206604
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: