Organization
PNMC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ERIC M BLAKE (IDC)
(757) 953-8726
Entity
Organization
Contact information
Practice address
1115 PEDDARS WAY, NORFOLK, VA 23505-1429
(757) 953-8726
Mailing address
1721 TAUSSIG BLVD, NORFOLK, VA 23511
(757) 953-8726
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
06/17/2008
Last updated
06/17/2008
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