Basic Information
| Provider Information | |||||||||
| NPI: | 1851429468 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UROLOGY OF VIRGINIA PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 13208 | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235060208 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1200 FIRST COLONIAL RD STE 100G | ||||||||
| Address2: | |||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234542264 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574813556 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2007 | ||||||||
| LastUpdateDate: | 11/20/2007 | ||||||||
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| AuthorizedOfficialLastName: | DELBRIDGE | ||||||||
| AuthorizedOfficialFirstName: | LORI | ||||||||
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| AuthorizedOfficialTitleorPosition: | CBO MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7574663410 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | UROLOGY OF VIRGINIA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.