Provider Demographics
NPI:1346260940
Name:COLONIAL INTERNAL MEDICINE ASSOCIATES PC
Entity Type:Organization
Organization Name:COLONIAL INTERNAL MEDICINE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCDOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-374-5599
Mailing Address - Street 1:125 OLDE GREENWICH DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-4001
Mailing Address - Country:US
Mailing Address - Phone:540-374-5599
Mailing Address - Fax:540-735-8097
Practice Address - Street 1:125 OLDE GREENWICH DR
Practice Address - Street 2:SUITE 300
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-4001
Practice Address - Country:US
Practice Address - Phone:540-374-5599
Practice Address - Fax:540-735-8097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102201579207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C09158Medicare ID - Type Unspecified