Provider Demographics
NPI:1952328304
Name:CENTRAL VIRGINIA ENT ASSOCIATES, INC
Entity Type:Organization
Organization Name:CENTRAL VIRGINIA ENT ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GRAHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GILMER III
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:434-947-3993
Mailing Address - Street 1:147 ABES WAY
Mailing Address - Street 2:
Mailing Address - City:RUSTBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24588-3128
Mailing Address - Country:US
Mailing Address - Phone:434-947-3993
Mailing Address - Fax:434-847-2941
Practice Address - Street 1:1330 OAK LN
Practice Address - Street 2:SUITE 201
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24503-2513
Practice Address - Country:US
Practice Address - Phone:434-947-3993
Practice Address - Fax:434-847-2941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2010-07-19
Deactivation Date:2009-09-01
Deactivation Code:
Reactivation Date:2010-04-30
Provider Licenses
StateLicense IDTaxonomies
VA207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty