Healthcare Provider Details

I. General information

NPI: 1508506783
Provider Name (Legal Business Name): KORY CABLAY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 LEE ST. BOX 800334
CHARLOTTESVILLE VA
22908-0816
US

IV. Provider business mailing address

1215 LEE ST. BOX 800334
CHARLOTTESVILLE VA
22908-0816
US

V. Phone/Fax

Practice location:
  • Phone: 434-924-9333
  • Fax: 434-244-7526
Mailing address:
  • Phone: 434-924-9333
  • Fax: 434-244-7526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberLL87699
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLL87699
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0116041626
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: