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General NPI Number Information
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NPI Number | 1659319275
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Entity Type | Organization
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Legal Business Name | PHYSICIAN ASSOCIATES OF VIRGINIA PC
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Dates
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Enumeration Date | 06/04/2006
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 1421 3RD ST SW
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City | ROANOKE
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State | VA
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Zip | 24016-5204
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Country | US
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Telephone | 540-345-4946
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Fax |
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Provider Business Mailing Address
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Address Line | 1421 3RD ST SW
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City | ROANOKE
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State | VA
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Zip | 24016-5204
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Country | US
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Telephone | 540-345-4946
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Fax | 540-982-7164
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Authorized Official
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Title or Position | CEO
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Name | MARION C OLSON
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Credential |
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Telephone | 540-767-9650
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0110001871
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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