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Organization
CAROLINA VASCULAR LABORATORY
Active
Organization
CAROLINA VASCULAR LABORATORY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID L GLENN JR. M.D. (MEDICAL DIRECTOR)
(828) 696-3833
Entity
Organization
Contact information
Practice address
420 5TH AVE W, SUITE 100, HENDERSONVILLE, NC 28739-4202
(828) 696-3833
(828) 693-6629
Mailing address
420 5TH AVE W, SUITE 100, HENDERSONVILLE, NC 28739-4202
(828) 696-3833
(828) 693-6629
Taxonomy
Speciality
Code
Description
License number
State
293D00000X
Physiological Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0194R
BLUE CROSS BLUE SHIELD NC
NC
05
—
8935971
—
NC
Enumeration date
09/15/2006
Last updated
08/22/2020
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