1174635163 NPI number — NEIL P DUBNER

Table of content: (NPI 1174635163)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174635163 NPI number — NEIL P DUBNER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEIL P DUBNER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174635163
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4127
Provider Second Line Business Mailing Address:
NEIL P DUBNER MD
Provider Business Mailing Address City Name:
ROANOKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24015-0127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-981-0672
Provider Business Mailing Address Fax Number:
540-344-7154

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 E MAIN ST
Provider Second Line Business Practice Location Address:
NEIL P DUBNER MD
Provider Business Practice Location Address City Name:
RADFORD
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24141-1826
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-639-4135
Provider Business Practice Location Address Fax Number:
540-639-6065
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FRAZIER
Authorized Official First Name:
AMY
Authorized Official Middle Name:
B
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
540-639-4135

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com