Provider Demographics
NPI:1093855983
Name:COLFER, MARY L (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:COLFER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 GASKINS RD STE A
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23238-1480
Mailing Address - Country:US
Mailing Address - Phone:804-774-7099
Mailing Address - Fax:804-528-5864
Practice Address - Street 1:2500 GASKINS RD STE A
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23238-1480
Practice Address - Country:US
Practice Address - Phone:804-774-7099
Practice Address - Fax:804-528-5864
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2019-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223345-1207P00000X
VA0101056632207P00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02212980Medicaid
RA2212Medicare ID - Type Unspecified
NY02212980Medicaid