Individual
DR. RANDAL STEVEN BLANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1215 LEE ST, CHARLOTTESVILLE, VA 22908-0001
(434) 984-2283
(434) 982-0019
Mailing address
PO BOX 9007, CHARLOTTESVILLE, VA 22906-9007
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
0101058927
VA
207LP2900X
Pain Medicine (Anesthesiology) Physician
0101058927
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
017182F85
MD MEDICARE GROUP G04185
MD
05
—
407012700
—
MD
01
—
601285800
FECA
—
01
—
839ML475
MD MEDICARE GROUP 839M
MD
Enumeration date
06/02/2006
Last updated
07/23/2021
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