Provider Demographics
NPI:1629428370
Name:APPALACHIAN REGIONAL MEDICAL ASSOCIATES INC
Entity Type:Organization
Organization Name:APPALACHIAN REGIONAL MEDICAL ASSOCIATES INC
Other - Org Name:THE HARRIET AND CHARLES DAVANT MEDICAL CLINIC AT CHESTNUT RIDGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP MEDICAL STAFF RELATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ETTA
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-262-4133
Mailing Address - Street 1:623 CHESTNUT RIDGE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:BLOWING ROCK
Mailing Address - State:NC
Mailing Address - Zip Code:28605-0000
Mailing Address - Country:US
Mailing Address - Phone:828-262-4133
Mailing Address - Fax:828-262-4103
Practice Address - Street 1:623 CHESTNUT RIDGE PARKWAY
Practice Address - Street 2:
Practice Address - City:BLOWING ROCK
Practice Address - State:NC
Practice Address - Zip Code:28605-0000
Practice Address - Country:US
Practice Address - Phone:828-262-4133
Practice Address - Fax:828-262-4103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty