Organization
BLUE RIDGE PEDIATRIC & ADOLESCENT MEDICINE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA HARDEE (OFFICE MANAGER)
(828) 262-0100
Entity
Organization
Contact information
Practice address
579 GREENWAY RD, SUITE 200, BOONE, NC 28607-4809
(828) 262-0100
(828) 264-7592
Mailing address
579 GREENWAY RD, SUITE 200, BOONE, NC 28607-4809
(828) 262-0100
(828) 264-7592
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
39798
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0110K
BLUE CROSS BLUE SHIELD
NC
05
—
890110K
—
NC
Enumeration date
08/31/2006
Last updated
01/10/2012
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