| Fountain Square Internal Medicine | |
|
1315 2nd St Sw Ste 101 Roanoke VA 24016-4935 | |
| (540) 344-5550 | |
| (540) 344-5205 |
| Full Name | Fountain Square Internal Medicine |
|---|---|
| Speciality | Internal Medicine |
| Location | 1315 2nd St Sw, Roanoke, Virginia |
| Authorized Official Name and Position | Michael Alan Malpass (PRESIDENT) |
| Authorized Official Contact | 5403445550 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fountain Square Internal Medicine 1315 2nd St Sw Ste 101 Roanoke VA 24016-4935 Ph: (540) 344-5550 | Fountain Square Internal Medicine 1315 2nd St Sw Ste 101 Roanoke VA 24016-4935 Ph: (540) 344-5550 |
| NPI Number | 1215090683 |
|---|---|
| Provider Enumeration Date | 12/18/2006 |
| Last Update Date | 01/28/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215090683 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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