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NPI Code Detail

MEDICARE: DANVILLE UROLOGIC CLINIC INC

MEDICARE: DANVILLE UROLOGIC CLINIC INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208800000XUrology PhysicianVA
2207RN0300XNephrology PhysicianVA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3DC7953OTHERVARAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1171773OTHERVAANTHEM GROUP NUMBER
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1619927100
Entity Type Code : Organization
Provider Name (Legal Business Name) : DANVILLE UROLOGIC CLINIC INC
Provider Business Mailing Address
First Line : 1040 MAIN ST
Second Line : P.O. BOX 1360
City : DANVILLE
State : VA
Zip : 24541-1816
Country : US
Telephone Number : 434-792-1433
Fax Number : 434-797-2807
Provider Business Practice Location Address
First Line : 1040 MAIN ST
Second Line :
City : DANVILLE
State : VA
Zip : 24541-1816
Country : US
Telephone Number : 434-792-1433
Fax Number : 434-797-2807
Authorized Official
Title or Position : PRESIDENT
Name : DR. JOSEPH M CARBONE
Credential : MD
Telephone Number : 434-792-1433
Provider Enumeration Date : 05/12/2006
Last Update Date : 09/07/2023

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1699730341 — DR. MICHAEL ROY FREDERICKS M.D.
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1245282458 — DR. JOSEPH M CARBONE MD
Practice Location Address:
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DANVILLE, VA
24541-1816
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Practice Fax: 434-797-2807
1134173123 — DR. FLORENCIO B GARCIA JR. MD
Practice Location Address:
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24541-1816
Practice Phone: 434-792-1433
Practice Fax: 434-797-2807

Directions to “DANVILLE UROLOGIC CLINIC INC ” Practice Location

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