Organization
BLUE RIDGE UROLOGICAL ASSOC., PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARIE D BUCKLEY III MD (PRESIDENT)
(540) 345-3556
Entity
Organization
Contact information
Practice address
70 MEDICAL CENTER CIR, SUITE 208, FISHERSVILLE, VA 22939-2273
(540) 345-3556
(540) 342-2193
Mailing address
PO BOX 8310, ROANOKE, VA 24014-0310
(540) 345-3556
(540) 342-2193
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
0101033256
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011345
ANTHEM
VA
01
—
011346
ANTHEM
VA
01
—
049990
ANTHEM
VA
01
—
279040
ANTHEM
VI
01
—
440822
ANTHEM
VA
Enumeration date
07/22/2006
Last updated
03/07/2008
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