Healthcare Provider Details

I. General information

NPI: 1619927100
Provider Name (Legal Business Name): DANVILLE UROLOGIC CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 MAIN ST
DANVILLE VA
24541-1816
US

IV. Provider business mailing address

1040 MAIN ST P.O. BOX 1360
DANVILLE VA
24541-1816
US

V. Phone/Fax

Practice location:
  • Phone: 434-792-1433
  • Fax: 434-797-2807
Mailing address:
  • Phone: 434-792-1433
  • Fax: 434-797-2807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number StateVA

VIII. Authorized Official

Name: DR. JOSEPH M CARBONE
Title or Position: PRESIDENT
Credential: MD
Phone: 434-792-1433