Provider Demographics
NPI:1912269598
Name:JAMES B. BLITCH, JR., M.D, PC
Entity Type:Organization
Organization Name:JAMES B. BLITCH, JR., M.D, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BLITCH
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:703-435-4434
Mailing Address - Street 1:1810 MICHAEL FARADAY DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5353
Mailing Address - Country:US
Mailing Address - Phone:703-435-4434
Mailing Address - Fax:703-435-1704
Practice Address - Street 1:1810 MICHAEL FARADAY DR
Practice Address - Street 2:SUITE 204
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5353
Practice Address - Country:US
Practice Address - Phone:703-435-4434
Practice Address - Fax:703-435-1704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010205082084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty