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Organization
BLUE RIDGE ACADEMIC MEDICAL GROUP, PLC
Active
Organization
BLUE RIDGE ACADEMIC MEDICAL GROUP, PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ISAAC J KIRSTEIN D.O. (PHYSICIAN)
(540) 818-5890
Entity
Organization
Contact information
Practice address
3700 S MAIN ST, BLACKSBURG, VA 24060-7017
(540) 951-1111
Mailing address
2265 KRAFT DR, BLACKSBURG, VA 24060-6360
(540) 818-5891
Taxonomy
Speciality
Code
Description
License number
State
204C00000X
Sports Medicine (Neuromusculoskeletal Medicine) Physician
Primary
0102201473
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
279560
ANTHEM
VA
01
—
DA5070
RAILROAD MEDICARE
VA
Enumeration date
03/29/2006
Last updated
08/22/2020
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