Provider Demographics
NPI:1356432892
Name:BLUE RIDGE FAMILY MEDICINE PLC
Entity type:Organization
Organization Name:BLUE RIDGE FAMILY MEDICINE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:K
Authorized Official - Last Name:WEISMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-213-3633
Mailing Address - Street 1:PO BOX 4127
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24015-0127
Mailing Address - Country:US
Mailing Address - Phone:540-981-9394
Mailing Address - Fax:540-344-7154
Practice Address - Street 1:42 LAMBERT ST STE 422
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-2421
Practice Address - Country:US
Practice Address - Phone:540-213-3633
Practice Address - Fax:540-344-7154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C09915Medicare PIN