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General NPI Number Information
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NPI Number | 1265538342
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Entity Type | Organization
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Legal Business Name | CAROLINA VASCULAR LABORATORY
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 420 5TH AVE W SUITE 100
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City | HENDERSONVILLE
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State | NC
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Zip | 28739-4202
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Country | US
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Telephone | 828-696-3833
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Fax | 828-693-6629
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Provider Business Mailing Address
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Address Line | 420 5TH AVE W SUITE 100
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City | HENDERSONVILLE
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State | NC
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Zip | 28739-4202
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Country | US
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Telephone | 828-696-3833
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Fax | 828-693-6629
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. DAVID L GLENN JR.
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Credential | M.D.
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Telephone | 828-696-3833
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 293D00000X
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Taxonomy Name | Physiological Laboratory
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License Number |
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License Number State |
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