Provider Demographics
NPI:1548334519
Name:NACK, STEVEN DOUGLAS (DO)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:DOUGLAS
Last Name:NACK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:210 PROFESSIONAL PARK DRIVE
Mailing Address - Street 2:SUITE 12
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060
Mailing Address - Country:US
Mailing Address - Phone:540-961-0410
Mailing Address - Fax:540-961-3925
Practice Address - Street 1:210 PROFESSIONAL PARK DRIVE
Practice Address - Street 2:SUITE 12
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060
Practice Address - Country:US
Practice Address - Phone:540-961-0410
Practice Address - Fax:540-961-3925
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01020368342084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
028196OtherBCBS OF VA
VA006183557Medicaid
VA006183557Medicaid
028196OtherBCBS OF VA
B06384Medicare UPIN