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General NPI Number Information
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NPI Number | 1215153127
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Entity Type | Individual
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Provider Name | DINA DAWSON BLACKSTOCK PAC
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Gender | Female
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 09/20/2024
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Provider Practice Location Address
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Address Line | 2091 LANGHORNE RD
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City | LYNCHBURG
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State | VA
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Zip | 24501-1428
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Country | US
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Telephone | 434-947-3954
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Fax | 877-583-4046
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Provider Business Mailing Address
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Address Line | PO BOX 2489
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City | FOREST
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State | VA
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Zip | 24551-6489
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Country | US
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Telephone | 434-382-1139
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Fax | 434-525-5748
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0110001206
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License Number State | VA
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