Provider Demographics
NPI:1477879955
Name:BLANSETT, ASHLEY GODWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:GODWIN
Last Name:BLANSETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:E
Other - Last Name:GODWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:190 CAMPUS BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2872
Mailing Address - Country:US
Mailing Address - Phone:540-667-1727
Mailing Address - Fax:540-722-3373
Practice Address - Street 1:190 CAMPUS BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2872
Practice Address - Country:US
Practice Address - Phone:540-667-1727
Practice Address - Fax:540-722-3373
Is Sole Proprietor?:No
Enumeration Date:2010-04-09
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013-00969208000000X
VA0101255961208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1477879955Medicaid
SCNC1837Medicaid
NCNCC781AMedicare PIN