Provider Demographics
NPI:1932337185
Name:BLANCO, RAMON RAYMOND (MD)
Entity type:Individual
Prefix:DR
First Name:RAMON
Middle Name:RAYMOND
Last Name:BLANCO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:10530 ROSEHAVEN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2840
Mailing Address - Country:US
Mailing Address - Phone:703-938-0363
Mailing Address - Fax:703-938-8653
Practice Address - Street 1:10530 ROSEHAVEN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2840
Practice Address - Country:US
Practice Address - Phone:703-938-0363
Practice Address - Fax:703-938-8653
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2023-11-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301094992207Q00000X, 390200000X
VA0101253434207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program