Provider Demographics
NPI:1417935636
Name:UROLOGY OF VIRGINIA, PC
Entity Type:Organization
Organization Name:UROLOGY OF VIRGINIA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:S
Authorized Official - Last Name:DELBRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-466-3410
Mailing Address - Street 1:PO BOX 791254
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279-1254
Mailing Address - Country:US
Mailing Address - Phone:757-466-0800
Mailing Address - Fax:757-466-1310
Practice Address - Street 1:6333 CENTER DR
Practice Address - Street 2:BLDG. 16
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-4126
Practice Address - Country:US
Practice Address - Phone:757-466-0800
Practice Address - Fax:757-466-1310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-06
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA=========OtherTAX ID FOR COMMERCIAL INS
VA=========OtherTAX ID FOR COMMERCIAL INS
VACD0393Medicare PIN
VAC05995Medicare PIN
C05230Medicare PIN
VAC05441Medicare PIN