Individual
BLECK B NGWAFANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
13540 HULL STREET RD, C/O TONYA AGOSTO, MIDLOTHIAN, VA 23112-2107
(804) 739-6142
Mailing address
13540 HULL STREET RD, MIDLOTHIAN, VA 23112-2107
(804) 739-6142
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101267223
VA
207Q00000X
Family Medicine Physician
101267223
VA
208M00000X
Hospitalist Physician
0101267223
VA
Other
Enumeration date
05/11/2017
Last updated
10/05/2021
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