Individual
OMAR A BLANCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
601 CHILDRENS LN, NORFOLK, VA 23507-1910
(757) 668-9219
Mailing address
601 CHILDRENS LN, NORFOLK, VA 23507-1910
(757) 668-9219
Taxonomy
Speciality
Code
Description
License number
State
207PP0204X
Pediatric Emergency Medicine (Emergency Medicine) Physician
Primary
0101222303
VA
208000000X
Pediatrics Physician
0101222303
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6732305
—
VA
Enumeration date
09/20/2006
Last updated
04/29/2020
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