Healthcare Provider Details

I. General information

NPI: 1922163286
Provider Name (Legal Business Name): CARDIOLOGY CONSULTANTS OF DANVILLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 06/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 EXECUTIVE DRIVE
DANVILLE VA
24541-4100
US

IV. Provider business mailing address

158 EXECUTIVE DRIVE
DANVILLE VA
24541-4100
US

V. Phone/Fax

Practice location:
  • Phone: 434-791-1088
  • Fax: 434-799-8525
Mailing address:
  • Phone: 434-791-1088
  • Fax: 434-799-8525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateVA

VIII. Authorized Official

Name: MRS. SUSAN CARTER MUSTAIN
Title or Position: INSURANCE MANAGER
Credential:
Phone: 434-791-1088