Provider Demographics
NPI:1538153796
Name:BIVENS, CARL H JR (MD)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:H
Last Name:BIVENS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 COLONIAL GREEN CIRCLE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018
Mailing Address - Country:US
Mailing Address - Phone:540-344-3276
Mailing Address - Fax:540-342-4399
Practice Address - Street 1:3501 COLONIAL GREEN CIRCLE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018
Practice Address - Country:US
Practice Address - Phone:540-344-3276
Practice Address - Fax:540-342-4399
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101018544207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09176OtherCVFP MEDICARE GRP#
255540OtherSOUTHERN HEALTH
4242797OtherAETNA
105576OtherANTHEM
VA5820430Medicaid
VA1528155892OtherCVFP CORPORATE NPI #
3300188OtherUNITED HEALTHCARE GROUP
VA1518054741OtherCVFP SITE NPI
VA1518054741OtherCVFP SITE NPI
3300188OtherUNITED HEALTHCARE GROUP
VA00W044C01Medicare PIN
VA5820430Medicaid