Individual
DINA DAWSON BLACKSTOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
2091 LANGHORNE RD, LYNCHBURG, VA 24501-1428
(434) 947-3954
(877) 583-4046
Mailing address
PO BOX 2489, FOREST, VA 24551-6489
(434) 382-1139
(434) 525-5748
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110001206
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00451415
MEDICARE RAILROAD PROVIDER NUMBER
—
Enumeration date
04/18/2007
Last updated
09/20/2024
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