1265616221 NPI number — FIRST MED OF WILLIAMSBURG

Table of content: (NPI 1265616221)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265616221 NPI number — FIRST MED OF WILLIAMSBURG

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRST MED OF WILLIAMSBURG
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265616221
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/26/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
312 SECOND STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLIAMSBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23185
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-229-4141
Provider Business Mailing Address Fax Number:
757-229-1792

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
312 SECOND STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLIAMSBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23185
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-229-4141
Provider Business Practice Location Address Fax Number:
757-229-1792
Provider Enumeration Date:
12/26/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CAMPANA
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
757-229-4141

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  0101035546 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: 0101051684VA , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)