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General NPI Number Information
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NPI Number | 1558575951
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Entity Type | Organization
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Legal Business Name | B & B MEDICAL PC
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 01/14/2008
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Provider Practice Location Address
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Address Line | 280 VA AVE NE STE 102
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City | NORTON
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State | VA
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Zip | 24273
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Country | US
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Telephone | 276-679-0818
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Fax | 276-679-9128
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Provider Business Mailing Address
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Address Line | 280 VA AVE NE STE 102
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City | NORTON
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State | VA
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Zip | 24273
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Country | US
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Telephone | 276-679-0818
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Fax | 276-679-9128
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Authorized Official
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Title or Position | PRESIDENT
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Name | THONGDANG BANCHUIN
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Credential | MD
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Telephone | 276-679-0818
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 0101029458
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 0101029458
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License Number State | VA
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