Provider Demographics
NPI:1518282680
Name:ADULT AND PEDIATRIC UROLOGY ASSOCIATES,INC
Entity Type:Organization
Organization Name:ADULT AND PEDIATRIC UROLOGY ASSOCIATES,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:LANYI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-285-9201
Mailing Address - Street 1:7601 FOREST AVE
Mailing Address - Street 2:SUITE 338
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-4933
Mailing Address - Country:US
Mailing Address - Phone:804-285-9201
Mailing Address - Fax:804-285-9202
Practice Address - Street 1:7601 FOREST AVE
Practice Address - Street 2:SUITE 338
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4933
Practice Address - Country:US
Practice Address - Phone:804-285-9201
Practice Address - Fax:804-285-9202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-01
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101032960261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007501986Medicaid
VA007501986Medicaid