Healthcare Provider Details

I. General information

NPI: 1760439483
Provider Name (Legal Business Name): PIEDMONT INTERNAL MEDICINE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 12/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 EXECUTIVE DR SUITE H
DANVILLE VA
24541-4155
US

IV. Provider business mailing address

125 EXECUTIVE DR SUITE H
DANVILLE VA
24541-4155
US

V. Phone/Fax

Practice location:
  • Phone: 434-791-1345
  • Fax:
Mailing address:
  • Phone: 434-791-1345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: VICKIE E MOSS
Title or Position: OFFICE MANAGER
Credential:
Phone: 434-791-1345