Provider Demographics
NPI:1083794705
Name:ASHEBORO UROLOGY CLINIC, PA
Entity Type:Organization
Organization Name:ASHEBORO UROLOGY CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DALJIT
Authorized Official - Middle Name:S
Authorized Official - Last Name:CABERWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-625-3997
Mailing Address - Street 1:283 WHITE OAK ST
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-5431
Mailing Address - Country:US
Mailing Address - Phone:336-625-3997
Mailing Address - Fax:
Practice Address - Street 1:283 WHITE OAK ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-5431
Practice Address - Country:US
Practice Address - Phone:336-625-3997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8901077Medicaid
NC01077OtherBCBS
NC8901077Medicaid