1831196872 NPI number — WILLIAMSBURG NEUROLOGY, P.C.

Table of content: (NPI 1831196872)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831196872 NPI number — WILLIAMSBURG NEUROLOGY, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLIAMSBURG NEUROLOGY, P.C.
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:
1831196872
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 KINGS WAY
Provider Second Line Business Mailing Address:
SUITE 2700
Provider Business Mailing Address City Name:
WILLIAMSBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23185-2505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-221-0110
Provider Business Mailing Address Fax Number:
757-221-0851

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 KINGS WAY
Provider Second Line Business Practice Location Address:
SUITE 2700
Provider Business Practice Location Address City Name:
WILLIAMSBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23185-2505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-221-0110
Provider Business Practice Location Address Fax Number:
757-221-0851
Provider Enumeration Date:
07/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BRAINARD
Authorized Official First Name:
SHAWN
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
MEDICAL PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
757-345-3907

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  0101048000 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: 0101052740 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6104215 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 270420 . This is a "ANTHEM GROUP NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 322877 . This is a "HARDING-ANTHEM BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 84282 . This is a "HARDING-SOUTHERN HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 95834 . This is a "SOUEIDAN-SOUTHERN HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 6154085 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 270421 . This is a "SOUEIDAN-ANTHEM BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 45061 . This is a "SOUEIDAN-SENTARA PROVIDER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 54560 . This is a "HARDING-SENTARA PROVIDERU" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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