Provider Demographics
NPI:1003895889
Name:D R BLAND MD PA
Entity Type:Organization
Organization Name:D R BLAND MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEIRDRE
Authorized Official - Middle Name:ROBINSON
Authorized Official - Last Name:BLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-774-9000
Mailing Address - Street 1:201 EXECUTIVE PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1503
Mailing Address - Country:US
Mailing Address - Phone:336-774-9000
Mailing Address - Fax:336-774-9012
Practice Address - Street 1:201 EXECUTIVE PARK BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1503
Practice Address - Country:US
Practice Address - Phone:336-774-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-11
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC36315207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC36315OtherNC STATE LICENSE
NC2329864OtherMEDICARE GROUP #
NC2182382BMedicare PIN
NC2329864OtherMEDICARE GROUP #