Provider Demographics
NPI:1861734691
Name:WYTHE BLAND PEDIATRICS
Entity type:Organization
Organization Name:WYTHE BLAND PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:ANEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:276-228-2405
Mailing Address - Street 1:590 W RIDGE RD
Mailing Address - Street 2:SUITE J
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-1094
Mailing Address - Country:US
Mailing Address - Phone:276-228-2405
Mailing Address - Fax:276-228-4573
Practice Address - Street 1:590 W RIDGE RD
Practice Address - Street 2:SUITE J
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-1094
Practice Address - Country:US
Practice Address - Phone:276-228-2405
Practice Address - Fax:276-228-4573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101251748208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty