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General NPI Number Information
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NPI Number | 1861734691
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Entity Type | Organization
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Legal Business Name | WYTHE BLAND PEDIATRICS
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Dates
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Enumeration Date | 03/19/2013
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Last Update Date | 03/19/2013
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Provider Practice Location Address
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Address Line | 590 W RIDGE RD SUITE J
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City | WYTHEVILLE
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State | VA
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Zip | 24382-1094
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Country | US
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Telephone | 276-228-2405
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Fax | 276-228-4573
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Provider Business Mailing Address
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Address Line | 590 W RIDGE RD SUITE J
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City | WYTHEVILLE
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State | VA
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Zip | 24382-1094
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Country | US
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Telephone | 276-228-2405
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Fax | 276-228-4573
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Authorized Official
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Title or Position | PEDIATRICIAN/OWNER
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Name | DR. MATTHEW ANEY
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Credential | M.D.
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Telephone | 276-228-2405
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 0101251748
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License Number State | VA
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