Basic Information
Provider Information
NPI: 1881019909
EntityType: 2
ReplacementNPI:  
OrganizationName: BLUE RIDGE UROGYNECOLOGY, INC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3800 ELECTRIC RD
Address2: SUITE 405
City: ROANOKE
State: VA
PostalCode: 240184569
CountryCode: US
TelephoneNumber: 5404809719
FaxNumber: 5403422193
Practice Location
Address1: 3800 ELECTRIC RD
Address2: SUITE 405
City: ROANOKE
State: VA
PostalCode: 240184569
CountryCode: US
TelephoneNumber: 5404809719
FaxNumber: 5403422193
Other Information
ProviderEnumerationDate: 02/26/2014
LastUpdateDate: 02/26/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: DAUCHER
AuthorizedOfficialFirstName: JAMES
AuthorizedOfficialMiddleName: A
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 5404809719
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207VF0040X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery

No ID Information.


Home