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General NPI Number Information
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NPI Number | 1538153796
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Entity Type | Individual
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Provider Name | CARL H BIVENS JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/02/2005
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Last Update Date | 12/02/2021
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Provider Practice Location Address
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Address Line | 3501 COLONIAL GREEN CIRCLE
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City | ROANOKE
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State | VA
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Zip | 24018
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Country | US
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Telephone | 540-344-3276
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Fax | 540-342-4399
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Provider Business Mailing Address
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Address Line | 3501 COLONIAL GREEN CIRCLE
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City | ROANOKE
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State | VA
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Zip | 24018
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Country | US
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Telephone | 540-344-3276
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Fax | 540-342-4399
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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 | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 0101018544
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License Number State | VA
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