Individual
JOHN LOUIS BLANCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
300 FOXCROFT AVE, SUITE 202B, MARTINSBURG, WV 25401-5341
(304) 263-4967
(304) 267-0974
Mailing address
300 FOXCROFT AVE STE 202B, MARTINSBURG, WV 25401-5341
(304) 263-4967
(304) 267-5461
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
20314
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000150164
WV BCBS
WV
05
—
022130900
—
MD
05
—
1801316000
—
WV
Enumeration date
06/20/2006
Last updated
02/19/2013
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