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General NPI Number Information
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NPI Number | 1528330800
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Entity Type | Organization
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Legal Business Name | WALTER B. BLAIR,M.D., INC
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Dates
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Enumeration Date | 02/02/2012
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Last Update Date | 02/02/2012
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Provider Practice Location Address
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Address Line | 5115 BERNARD DR SUITE 101
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City | ROANOKE
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State | VA
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Zip | 24018-4357
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Country | US
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Telephone | 540-774-5861
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Fax | 540-776-9969
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Provider Business Mailing Address
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Address Line | 5115 BERNARD DR SUITE 101
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City | ROANOKE
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State | VA
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Zip | 24018-4357
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Country | US
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Telephone | 540-774-5861
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Fax | 540-776-9969
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Authorized Official
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Title or Position | SOLE OWNER
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Name | DR. WALTER B. BLAIR
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Credential | M.D.
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Telephone | 540-774-5861
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 0101022440
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License Number State | VA
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