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General NPI Number Information
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NPI Number | 1093713950
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Entity Type | Individual
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Provider Name | CHARLES E. DRISCOLL M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/13/2005
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Last Update Date | 04/28/2009
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Provider Practice Location Address
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Address Line | 2323 MEMORIAL AVE SUITE 10
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City | LYNCHBURG
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State | VA
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Zip | 24501-2661
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Country | US
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Telephone | 434-947-5200
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Fax |
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Provider Business Mailing Address
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Address Line | 1204 FENWICK DR
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City | LYNCHBURG
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State | VA
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Zip | 24502-2112
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101224139
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 0101224139
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License Number State | VA
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