Provider Demographics
NPI:1225079650
Name:WILLIAMSBURG EMERGENCY PHYSICIANS
Entity Type:Organization
Organization Name:WILLIAMSBURG EMERGENCY PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AO
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZYDRON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-719-9003
Mailing Address - Street 1:PO BOX 2915
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23187-2915
Mailing Address - Country:US
Mailing Address - Phone:757-221-0055
Mailing Address - Fax:757-221-8085
Practice Address - Street 1:100 SENTARA CIR
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-5713
Practice Address - Country:US
Practice Address - Phone:757-221-0055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CE8290OtherRAILROAD MEDICARE
CE8290OtherRAILROAD MEDICARE