Provider Demographics
NPI:1720048630
Name:BLOSSER, RICHARD ALLEN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALLEN
Last Name:BLOSSER
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:3700 JOSEPH SIEWICK DR
Mailing Address - Street 2:SUITE 401
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-1744
Mailing Address - Country:US
Mailing Address - Phone:703-281-1023
Mailing Address - Fax:703-620-2331
Practice Address - Street 1:3700 JOSEPH SIEWICK DR
Practice Address - Street 2:SUITE 401
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1744
Practice Address - Country:US
Practice Address - Phone:703-281-1023
Practice Address - Fax:703-620-2331
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2007-08-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VAV0101044124207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6077501Medicaid
VAF54744Medicare UPIN
VA6077501Medicaid