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General NPI Number Information
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NPI Number | 1316155047
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Entity Type | Individual
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Provider Name | SUSAN K BLANK MD
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Gender | Female
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 07/08/2015
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Provider Practice Location Address
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Address Line | 924 RUGBY RD
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22903-1606
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Country | US
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Telephone | 434-466-3147
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Fax |
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Provider Business Mailing Address
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Address Line | 924 RUGBY RD
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22903-1606
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Country | US
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Telephone | 434-466-3147
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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 | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 0101237491
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License Number State | VA
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