Organization
ROANOKE NEUROSURGERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BUDDY BLACKWOOD (VP)
(540) 772-3527
Entity
Organization
Contact information
Practice address
2766 ELECTRIC RD, SUITE A, ROANOKE, VA 24018-3583
(540) 989-6516
Mailing address
2766 ELECTRIC RD, SUITE A, ROANOKE, VA 24018-3583
(540) 989-6516
(540) 989-6516
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1336184084
—
VA
01
—
DB1008
RR MEDICARE
—
Enumeration date
06/17/2006
Last updated
01/08/2009
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