Provider Demographics
NPI:1477682730
Name:UROLOGY OF VIRGINIA PC
Entity Type:Organization
Organization Name:UROLOGY OF VIRGINIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CBO DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:DELBRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-466-3410
Mailing Address - Street 1:PO BOX 13208
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23506-0208
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3105 WESTERN BRANCH BLVD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5543
Practice Address - Country:US
Practice Address - Phone:757-686-1973
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UROLOGY OF VIRGINIA PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-05
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5533240011Medicare NSC