Healthcare Provider Details

I. General information

NPI: 1134169329
Provider Name (Legal Business Name): EDWIN HARVIE JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HOLBROOK ST
DANVILLE VA
24541-1732
US

IV. Provider business mailing address

101 HOLBROOK ST
DANVILLE VA
24541-1732
US

V. Phone/Fax

Practice location:
  • Phone: 434-792-4041
  • Fax: 434-792-0124
Mailing address:
  • Phone: 434-792-4041
  • Fax: 434-792-0124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101013597
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: