Provider Demographics
NPI:1497412738
Name:BLUE RIDGE ALLERGY AND ASTHMA, PLLC
Entity Type:Organization
Organization Name:BLUE RIDGE ALLERGY AND ASTHMA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-263-5695
Mailing Address - Street 1:870 STATE FARM RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-4862
Mailing Address - Country:US
Mailing Address - Phone:828-264-4545
Mailing Address - Fax:828-263-5698
Practice Address - Street 1:870 STATE FARM RD STE 101
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4862
Practice Address - Country:US
Practice Address - Phone:828-264-4545
Practice Address - Fax:828-263-5698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty