Dwayne Hargrove
Individual provider Active NPI Driver · Rustburg, VA
NPI 1043713399 · NPPES record last updated Mar 13, 2018
Key facts
- NPI
- 1043713399
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Driver 172A00000X
- License
- T60723797 (VA)
- Practice address
- 339 Cherry Hill Dr
Rustburg, VA 24588-4244 - Phone
- (434) 509-9100
- NPI assigned
- Mar 13, 2018
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| T60723797 | VA | MD | Driver |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | T60723797 | VA | Yes |
Addresses
Primary practice location
339 Cherry Hill Dr
Rustburg, VA 24588-4244
Mailing address
339 Cherry Hill Dr
Rustburg, VA 24588-4244
Phone (434) 509-9100
Other providers in Rustburg, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 13, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.