MEDICARE: D R BLAND MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VG0400X	Gynecology Physician	36315	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	2329864	OTHER	NC	MEDICARE GROUP #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	36315	OTHER	NC	NC STATE LICENSE

General Provider Information

NPI Number	:	1003895889
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	D R BLAND MD PA

Provider Business Mailing Address
First Line	:	201 EXECUTIVE PARK BLVD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-1503
Country	:	US
Telephone Number	:	336-774-9000
Fax Number	:	336-774-9012

Provider Business Practice Location Address
First Line	:	201 EXECUTIVE PARK BLVD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-1503
Country	:	US
Telephone Number	:	336-774-9000
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DEIRDRE ROBINSON BLAND
Credential	:	MD
Telephone Number	:	336-774-9000

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	01/23/2008

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Directions to “D R BLAND MD PA ” Practice Location

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