Provider Demographics
NPI:1528330800
Name:WALTER B. BLAIR,M.D., INC
Entity type:Organization
Organization Name:WALTER B. BLAIR,M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:B
Authorized Official - Last Name:BLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-774-5861
Mailing Address - Street 1:5115 BERNARD DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-4357
Mailing Address - Country:US
Mailing Address - Phone:540-774-5861
Mailing Address - Fax:540-776-9969
Practice Address - Street 1:5115 BERNARD DR
Practice Address - Street 2:SUITE 101
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-4357
Practice Address - Country:US
Practice Address - Phone:540-774-5861
Practice Address - Fax:540-776-9969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101022440261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
1144248386Medicare Oscar/Certification