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Individual

CLOVER CHARLES

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
476 OAKLEY AVE, LYNCHBURG, VA 24501-3647
(434) 444-2579
Mailing address
476 OAKLEY AVE, LYNCHBURG, VA 24501-3647
(434) 444-2579

Taxonomy

Speciality
Code
Description
License number
State
224P00000X
Prosthetist
Primary
1201133686
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
NONE
NONE
Enumeration date
01/02/2019
Last updated
12/30/2020
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