Basic Information
| Provider Information | |||||||||
| NPI: | 1073592069 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUBNER | ||||||||
| FirstName: | NEIL | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4127 | ||||||||
| Address2: | NEIL P DUBNER MD | ||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240150127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5409810672 | ||||||||
| FaxNumber: | 5403447154 | ||||||||
| Practice Location | |||||||||
| Address1: | 7514 LEE HIGHWAY | ||||||||
| Address2: | NEIL P DUBNER MD | ||||||||
| City: | RADFORD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 24141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5406394135 | ||||||||
| FaxNumber: | 5406396065 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2006 | ||||||||
| LastUpdateDate: | 10/22/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 0101040158 | VA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | P00366125 | 01 | MEDICARE RAILROAD | OTHER | 146385 | 01 | ANTHEM | OTHER |