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General NPI Number Information
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NPI Number | 1124530845
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Entity Type | Individual
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Provider Name | KEVIN GLEIM
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Gender | Male
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Dates
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Enumeration Date | 11/03/2017
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 2001 CRYSTAL SPRING AVE SW
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City | ROANOKE
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State | VA
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Zip | 24014-2462
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Country | US
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Telephone | 540-981-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 213 S JEFFERSON ST STE 1006
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City | ROANOKE
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State | VA
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Zip | 24011-1713
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Country | US
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Telephone | 540-224-5353
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 0110010529
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9111118
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License Number State | FL
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