| Organization Name: | PRIVATE DIAGNOSTIC CLINIC, PLLC |
| NPI Number: | 1053507681 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARK L. CANTRELL (CHIEF COMPLIANCE OFFICER) |
| Mailing Address: | 750 Lombardy St South Hill |
| State: | VA US |
| Postal Code: | 239702112 |
| Phone Number: | 4347742417 |
| Fax Number: | |
| NPI Enumeration Date: | 09/18/2007 |
| NPI Last Update Date: | 03/05/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207RH0003X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Internal Medicine |
| Taxonomy Specialization: | Hematology & Oncology |
| Taxonomy Definition: | An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered. |