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General NPI Number Information
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NPI Number | 1205258829
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Entity Type | Organization
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Legal Business Name | ROANOKE ADULT MEDICINE LLC
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Dates
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Enumeration Date | 01/16/2014
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Last Update Date | 01/16/2014
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Provider Practice Location Address
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Address Line | 1708 CLAY ST SE
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City | ROANOKE
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State | VA
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Zip | 24013-2105
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Country | US
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Telephone | 540-309-7569
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Fax |
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Provider Business Mailing Address
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Address Line | 1708 CLAY ST SE
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City | ROANOKE
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State | VA
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Zip | 24013-2105
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Country | US
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Telephone | 540-309-7569
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | WILLIAM C WARD
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Credential | MD
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Telephone | 540-309-5769
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 0101024791
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License Number State | VA
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