Provider Demographics
NPI:1407031537
Name:VIRGINIA BEACH UROLOGICAL ASSOCIATES LTD
Entity Type:Organization
Organization Name:VIRGINIA BEACH UROLOGICAL ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:WARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD FACS MBA
Authorized Official - Phone:757-481-9402
Mailing Address - Street 1:1004 FIRST COLONIAL RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454
Mailing Address - Country:US
Mailing Address - Phone:757-481-9402
Mailing Address - Fax:757-481-0657
Practice Address - Street 1:1004 FIRST COLONIAL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454
Practice Address - Country:US
Practice Address - Phone:757-481-9402
Practice Address - Fax:757-481-0657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101031498208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B07618Medicare UPIN
340000050Medicare PIN