Provider Demographics
NPI:1457875106
Name:CAGE, EARL THOMAS I (ETC)
Entity Type:Individual
Prefix:MR
First Name:EARL
Middle Name:THOMAS
Last Name:CAGE
Suffix:I
Gender:M
Credentials:ETC
Other - Prefix:MR
Other - First Name:EARL
Other - Middle Name:THOMAS
Other - Last Name:CAGE
Other - Suffix:I
Other - Last Name Type:Former Name
Other - Credentials:ETC
Mailing Address - Street 1:646 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HALIFAX
Mailing Address - State:VA
Mailing Address - Zip Code:24558-3248
Mailing Address - Country:US
Mailing Address - Phone:434-579-6950
Mailing Address - Fax:434-476-7782
Practice Address - Street 1:646 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HALIFAX
Practice Address - State:VA
Practice Address - Zip Code:24558-3248
Practice Address - Country:US
Practice Address - Phone:434-579-6950
Practice Address - Fax:434-476-7782
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA172A00000X, 344600000X
172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi
No172A00000XOther Service ProvidersDriver