Organization
BLACKSBURG INTERNAL MEDICINE AND CARDIOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
J EDWIN WILDER MD (PRESIDENT)
(540) 953-0530
Entity
Organization
Contact information
Practice address
840 HOSPITAL DR, BLACKSBURG, VA 24060-7023
(540) 953-0530
(540) 953-0510
Mailing address
PO BOX 928, BLACKSBURG, VA 24063-0928
(540) 953-0530
(540) 953-0510
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
0101047913
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0101047913
VIRGINIA MEDICAL LICENSE
VA
Enumeration date
12/22/2008
Last updated
03/07/2023
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