Basic Information
| Provider Information | |||||||||
| NPI: | 1225624679 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VIRGINIA PULMONOLOGY AND CRITICAL CARE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4604 SPOTSYLVANIA PKWY STE 340 | ||||||||
| Address2: | |||||||||
| City: | FREDERICKSBRG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 224087767 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2767831827 | ||||||||
| FaxNumber: | 2767832879 | ||||||||
| Practice Location | |||||||||
| Address1: | 4604 SPOTSYLVANIA PKWY STE 340 | ||||||||
| Address2: | |||||||||
| City: | FREDERICKSBRG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 224087767 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2767831827 | ||||||||
| FaxNumber: | 2767832879 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2020 | ||||||||
| LastUpdateDate: | 04/21/2021 | ||||||||
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| AuthorizedOfficialLastName: | DOLOJAN | ||||||||
| AuthorizedOfficialFirstName: | JORGE | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN/SHAREHOLDER | ||||||||
| AuthorizedOfficialTelephone: | 3012132272 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 04/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
No ID Information.