Organization
SOUTH ROANOKE OB-GYN PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
W KEVIN WALSH MD (PRESIDENT)
(540) 345-3556
Entity
Organization
Contact information
Practice address
2110 CAROLINA AVE SW, 3RD FLOOR, ROANOKE, VA 24014-1702
(540) 345-3556
(540) 342-2193
Mailing address
PO BOX 8478, ROANOKE, VA 24014-0478
(540) 345-3556
(540) 342-2193
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
0101237419
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
179613
ANTHEM
VA
01
—
DD7281
RAILROAD MEDICARE
VA
Enumeration date
07/12/2006
Last updated
08/30/2007
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