Provider Demographics
NPI:1831141597
Name:INTERNAL MEDICINE OF ROANOKE PC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE OF ROANOKE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BOLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-344-3020
Mailing Address - Street 1:1315 2ND ST SW
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-4935
Mailing Address - Country:US
Mailing Address - Phone:540-344-3020
Mailing Address - Fax:540-344-4394
Practice Address - Street 1:1315 2ND ST SW
Practice Address - Street 2:SUITE 202
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4935
Practice Address - Country:US
Practice Address - Phone:540-344-3020
Practice Address - Fax:540-344-4394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06247Medicare ID - Type UnspecifiedGROUP #
VAP00911946Medicare PIN
VAVAA104681Medicare PIN
CG6014Medicare PIN