Healthcare Provider Details

I. General information

NPI: 1699757823
Provider Name (Legal Business Name): CHARLES EDWARD KOBER PA/C
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 RISON ST
DANVILLE VA
24541-2458
US

IV. Provider business mailing address

153 VIRGINIA AVE
DANVILLE VA
24541-3761
US

V. Phone/Fax

Practice location:
  • Phone: 434-797-1826
  • Fax:
Mailing address:
  • Phone: 434-429-6985
  • Fax: 434-432-7838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110001182
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: