Provider Demographics
NPI:1457323800
Name:COLONNA, JOHN OWNE II (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:OWNE
Last Name:COLONNA
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 GRESHAM DR STE 8620
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1904
Mailing Address - Country:US
Mailing Address - Phone:757-395-1600
Mailing Address - Fax:757-625-0433
Practice Address - Street 1:600 GRESHAM DR STE 8620
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1904
Practice Address - Country:US
Practice Address - Phone:757-395-1600
Practice Address - Fax:757-625-0433
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010493642086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
770003097OtherMEDICARE RAILROAD
VA7313152Medicaid
770003097OtherMEDICARE RAILROAD
020001579Medicare ID - Type Unspecified