Provider Demographics
NPI:1588662613
Name:BLANKS, VIRGINIA L (MD)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:L
Last Name:BLANKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4830 RUCKER RD
Mailing Address - Street 2:
Mailing Address - City:MONETA
Mailing Address - State:VA
Mailing Address - Zip Code:24121
Mailing Address - Country:US
Mailing Address - Phone:540-297-7181
Mailing Address - Fax:540-297-6145
Practice Address - Street 1:4830 RUCKER RD
Practice Address - Street 2:ATTN: VILLAGE FAMILY PHYSICIANS
Practice Address - City:MONETA
Practice Address - State:VA
Practice Address - Zip Code:24121
Practice Address - Country:US
Practice Address - Phone:540-297-7181
Practice Address - Fax:540-297-6145
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101045355207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5674115Medicaid
079273OtherANTHEM
BB2961224OtherDEA
079273OtherANTHEM
VA5674115Medicaid