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General NPI Number Information
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NPI Number | 1598734162
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Entity Type | Individual
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Provider Name | JOHN CARDWELL PA
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Gender | Male
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Dates
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Enumeration Date | 03/16/2006
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Last Update Date | 08/05/2015
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Provider Practice Location Address
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Address Line | 2410 ATHERHOLT RD
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City | LYNCHBURG
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State | VA
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Zip | 24501-2148
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Country | US
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Telephone | 434-200-5252
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Fax | 434-847-3645
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Provider Business Mailing Address
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Address Line | 2091 LANGHORNE RD
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City | LYNCHBURG
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State | VA
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Zip | 24501-1428
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Country | US
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Telephone | 434-947-3954
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Fax | 434-947-5944
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 0110001057
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License Number State | VA
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