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General NPI Number Information
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NPI Number | 1457469165
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Entity Type | Organization
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Legal Business Name | BLADEN MEDICAL ASSOCIATES
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 08/18/2008
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Provider Practice Location Address
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Address Line | 300 E MCKAY ST SUITE A
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City | ELIZABETHTOWN
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State | NC
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Zip | 28337-0517
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Country | US
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Telephone | 910-862-5500
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Fax | 910-862-2107
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Provider Business Mailing Address
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Address Line | PO BOX 517
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City | ELIZABETHTOWN
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State | NC
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Zip | 28337-0517
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Country | US
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Telephone | 910-862-5500
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Fax | 910-862-2107
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Authorized Official
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Title or Position | ADMINISTRATIVE ASSISTANT
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Name | MRS. DONNA L BOWEN
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Credential |
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Telephone | 910-862-5500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 22998
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 200101455
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 29651
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License Number State | NC
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