Provider Demographics
NPI:1255494332
Name:KNIGHT, AUBREY LEE (MD)
Entity Type:Individual
Prefix:
First Name:AUBREY
Middle Name:LEE
Last Name:KNIGHT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 CRYSTAL SPRING AVE SW
Mailing Address - Street 2:SUITE 302
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-2462
Mailing Address - Country:US
Mailing Address - Phone:540-981-7653
Mailing Address - Fax:540-981-7469
Practice Address - Street 1:2001 CRYSTAL SPRING AVE SW
Practice Address - Street 2:SUITE 302
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-2462
Practice Address - Country:US
Practice Address - Phone:540-981-7653
Practice Address - Fax:540-981-7469
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0035281207QG0300X
VA0101035672207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4073550-00Medicaid
VAMC10074OtherMEDICARE PTAN
VAVV8414AOtherMEDICARE PTAN
016878H23Medicare ID - Type Unspecified
MD4073550-00Medicaid