Provider Demographics
NPI:1316022874
Name:ASHEBORO UROLOGY CLINIC
Entity Type:Organization
Organization Name:ASHEBORO UROLOGY CLINIC
Other - Org Name:CHATHAM UROLOGY
Other - Org Type:Doing Business As
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:919-663-3317
Mailing Address - Street 1:401 N IVEY AVE
Mailing Address - Street 2:
Mailing Address - City:SILER CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27344-3074
Mailing Address - Country:US
Mailing Address - Phone:919-663-3317
Mailing Address - Fax:
Practice Address - Street 1:401 N IVEY AVE
Practice Address - Street 2:
Practice Address - City:SILER CITY
Practice Address - State:NC
Practice Address - Zip Code:27344-3074
Practice Address - Country:US
Practice Address - Phone:919-663-3317
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2008-01-07
Deactivation Date:2007-02-23
Deactivation Code:
Reactivation Date:2007-12-31
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC01077OtherBCBS
NC8901077Medicaid
NC2325107Medicare PIN