Healthcare Provider Details

I. General information

NPI: 1487767141
Provider Name (Legal Business Name): CARROLL PINTO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 GODWIN BLVD
SUFFOLK VA
23434-8038
US

IV. Provider business mailing address

PO BOX 5468
MARTINSVILLE VA
24115-5468
US

V. Phone/Fax

Practice location:
  • Phone: 757-562-3715
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberCLIA #49D0230995
License Number StateVA

VIII. Authorized Official

Name: DR. DANIEL GARLAND
Title or Position: PRESIDENT
Credential: M.D.
Phone: 757-562-2684